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From: CPNUES
Category: General
Date: 28 Mar 2002
Time: 02:13:57
Remote Name: 130.191.17.212
Great question Josh, So far, long term has been about 4-5 years for our sample. We have not had reoccurance issues, or loss of active flexion. A key factor in this is that we do test to make sure that the tricpes are active. It is also important to pre-operatively note that the flexors are active and not just spastic. As it is an "associated reaction" problem the pt usually has active triceps and flexors.
We do also advocate the use of dynamic emgs at the elbow if possible. It can help to define which flexor is active during associated reactions. (In the research section the project is described). If you do not have access to emgs, you could try surface biofeedback electrodes or palpation of the flexors during contralateral arm use to see if you can tell if one flexor is a primary problem.
Athetosis is a bit trickier. Many of our pts have some underlying dystonia/athetosis. The sample size of pts that have primarily athetoid involvement as a PRIMARY movement type is smaller. In these pts, however, what you look for is the fact that PERSISITANT flexion is interfering in function. I can think of one young woman who did tend to extend at rest, but during function was flexed and even "achey" (as she described it) in her elbow and wrist more often. Fractional lengthenings at the elbow and wrist performed nicely in her. It is the transfers that can pose more problems and our team tends to shy away from them in the athotoid population. If you cannot determine a consistent posture that with your patient, Botox is an excellent tool. The surgeon or physician can inject the elbow flexors and the pt can have a chance to function with limited flexors to see if they are more functional. Our team employs Botox injections in pts that present with more athetoid motion and find it really does augment decision making and improve pt confidence.(Botox can also be used if the team is uncertain of the primary flexor involvement in the absence of emgs.).
Good luck with your patient and keep in touch.CB
From: Cherea Jackson
Category: General
Date: 23 Aug 2006
Time: 22:42:48
Remote Name: 69.142.102.23
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From: Texas
Category: Constraints
Date: 30 Oct 2007
Time: 13:28:08
Remote Name: 148.233.159.58
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From:
Category: General
<option>E-Stim
<option>Constraints
<option>Handwriting
<option>Botox
Date: 29 Jan 2007
Time: 11:22:02
Remote Name: 195.175.37.8
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