Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study.

Acquired deforming hypertonia (ADH) affects the daily care of numerous nursing home residents. The aim of this study was to analyze the practice, aims, and effectiveness of botulinum toxin injections (BTxis) in the treatment of older patients with contractures, an indication for which BTxis are still underused. Data were extracted retrospectively from medical records regarding population, contractures, and injections. A prospective analysis was conducted to evaluate treatment goals set by goal attainment scaling (GAS) at T0 and at T1, to evaluate the therapeutic effects. We also recorded the occurrence of side effects, using a telephone questionnaire. This study included 41 patients older than 70 years who had received one or more BTxis for the first time between January 2018 and December 2021. Most of the older people we included lived in an institution (66%), manifested severe dependence, and presented significant morbi-mortality (37% of the patients died in the year after the last injection). The main objectives of these injections were purely comfort, without any functional goals. The GAS scores suggested effectiveness for comfort GAS scores. No complications were recorded. This study highlights the BTxis potential to address the needs of a larger number of older patients with ADH.

Prevention of pressure ulcers with a motorized air support in at-risk patients hospitalized in rehabilitation departments APAM + an observational prevalence study with historical control and incidence study.

BACKGROUND: The main study was a cross-sectional multicenter study of the prevalence of pressure ulcers in rehabilitation services (RS) where Axtair Automorpho® Plus mattresses were made available ad libitum. The primary objective was to enable comparison with prevalence as observed in the national PERSE study (historical control) in similar departments using a variety of prevention aids. METHODS: This cross-sectional prevalence study was combined with a prospective study of the incidence of pressure ulcer occurrence in the high-risk target population whose beds were systematically equipped with the studied support. RESULTS: On the day of the prevalence study, 18 of the 456 patients presented pressure ulcers which occurred during the period when Axtair Automorpho® Plus supports were made available to the departments. This corresponds to a prevalence of 3.9% [2.4, 6.2] which is significantly lower than those recorded in the PERSE study: 11.8% [10.8; 12.8] p <0.0001. The ulcer incidence study covers 57 patients who were hospitalized on a bed with an Axtair Automorpho® Plus support because of their risk of contracting pressure ulcers. One pressure ulcer occurred in 3 patients and 3 pressure ulcers occurred in another patient, i.e. 4 out of 57 corresponding to an incidence of 7.0% [2.0; 17.0]. CONCLUSIONS: The results of the pressure ulcer prevalence study in rehabilitation departments where Axtair Automorpho® Plus supports were available as well as results of the study of pressure ulcer incidence in patients bedridden on Axtair Automorpho® Plus, confirm the expected benefit provided to patients in terms of prevention.

[Botulinum toxin in the elderly to the care of limbs spastic hypertonia and toes or fingers dystonias]. / La toxine botulinique chez les sujets âgés dans la prise en charge de l'hypertonie spastique des membres et des dystonies des orteils ou des doigts.

OBJECTIVE: To show the botulinum toxin interest and limits in the elderly presenting a limbs spastic hypertonia and/or a dystonia, through a clinical study and a literature review. METHOD: We report a 6 years and 8 months retrospective single center study, concerning 49 patients, all of them was more than 70 years old and had received one or several botulinum toxin injections for a limbs spastic hypertonia and/or a dystonia. RESULTS: The population average was 76,9 years old (70 to 92 years old). It was possible to realize several sessions for the same patient if respecting a three months interval between two sessions. No major side effects was noticed. More than half of the patients felt a significant improvement of their life quality, their functional status and/or on pain. A multidisciplinary care was systematically associated with the botulinum toxin. CONCLUSION: The botulinum toxin is an additional asset for the spasticity care of the geriatric patient in rehabilitation, if indications and contraindications are advisedly targeted. The age cannot be considered as a limitating factor.