Barbara Singer - Academia.edu (original) (raw)

Papers by Barbara Singer

$Research paper thumbnail of The Role of Botulinum Toxin Type A in the Clinical Management of Refractory Anterior Knee Pain$

Toxins, 2015

Anterior knee pain is a highly prevalent condition affecting largely young to middle aged adults.... more Anterior knee pain is a highly prevalent condition affecting largely young to middle aged adults. Symptoms can recur in more than two thirds of cases, often resulting in activity limitation and reduced participation in employment and recreational pursuits. Persistent anterior knee pain is difficult to treat and many individuals eventually consider a surgical intervention. Evidence for long term benefit of most conservative treatments or surgical approaches is currently lacking. Injection of Botulinum toxin type A to the distal region of vastus lateralis muscle causes a short term functional &amp;amp;amp;quot;denervation&amp;amp;amp;quot; which moderates the influence of vastus lateralis muscle on the knee extensor mechanism and increases the relative contribution of the vastus medialis muscle. Initial data suggest that, compared with other interventions for anterior knee pain, Botulinum toxin type A injection, in combination with an active exercise programme, can lead to sustained relief of symptoms, reduced health care utilisation and increased activity participation. The procedure is less invasive than surgical intervention, relatively easy to perform, and is time- and cost-effective. Further studies, including larger randomized placebo-controlled trials, are required to confirm the effectiveness of Botulinum toxin type A injection for anterior knee pain and to elaborate the possible mechanisms underpinning pain and symptom relief.

International Journal of Therapy and Rehabilitation, 2015

Research Patientengagement andsatisfactionwithgoal planning:Impactonoutcome fromrehabilitation Ai... more Research Patientengagement andsatisfactionwithgoal planning:Impactonoutcome fromrehabilitation Aim: To examine the relationship between patient/family engagement in goal planning, satisfaction with the goal setting process and associated goal attainment and functional gains during rehabilitation. Method: A prospective cohort analysis of consecutively completed episodes for patients discharged over a 1-year period (January-December 2013) in a specialist neurological rehabilitation service in the UK. Participants were adults (n=83) with neurological disabilities (mean±SD age: 42.8 ±15.0 years; programme length: 98 ± 47 days; male to female ratio: 69 :31; diagnosis: brain injury (n=75, 90%), spinal cord injury (n=5, 6%), other neurological conditions (n=3, 4%)). The measures used were sixpoint visual analogue scales to rate goal engagement and goal satisfaction, Goal Attainment Scaling (GAS) and the UK Functional Assessment Measure (UK FIM+FAM). Results: Significant improvements were seen between admission and discharge for patient goal engagement (Mann-Whitney z=-2.2, p=0.027) and satisfaction (z=-2.2, p=0.031). Significant correlations were seen between goal engagement and goal satisfaction for patients on admission (Spearman's rho 0.41, p=0.03) and for their families on discharge (rho 0.82, p<0.001). Patients' goal engagement by discharge was strongly correlated with GAS achieved T-scores (rho 0.54, p<0.001) and with functional gain (change in FIM+FAM-Motor subscale rho 0.46, p<0.001).

American Intra-Ocular Implant Society Newsletter, 1975

Restorative neurology and neuroscience, 2013

We examined the feasibility and outcome of electromyographically triggered electrical muscle stim... more We examined the feasibility and outcome of electromyographically triggered electrical muscle stimulation (EMG-ES) plus unilateral or bilateral task specific practice on arm function in chronic stroke survivors with moderate-severe hemiplegia. Transcranial magnetic stimulation was used to examine inter-hemispheric inhibition (IHI) acting on the stroke-affected hemisphere in a subset of eight participants. Twenty-one stroke survivors (14 males; mean time post stroke 57.9 months) participated in this pilot investigation. Participants underwent a six-week program of daily EMG-ES training with random assignment to concurrent task practice using the stroke-affected hand only or both hands. The upper-extremity subscale of the Fugl-Meyer (FMUE) and the Arm Motor Ability Test (AMAT) were completed at baseline, 0-, 1-, and 3-months post-intervention. Following the intervention, FMUE (F(3, 57) = 3.89, p = .01, ηp2 = .17) and AMAT (F(3, 57) = 12.6, p = .01, ηp2 = .39) scores improved, and remai...

Archives of physical medicine and rehabilitation, 2004

To examine an adult population undergoing rehabilitation after brain injury to determine the inci... more To examine an adult population undergoing rehabilitation after brain injury to determine the incidence of ankle contracture and factors contributing to the development of this deformity. Descriptive study Specialist inpatient neurosurgical rehabilitation unit in Australia. Patients (N=105) admitted with a new diagnosis of moderate to severe brain injury over a 12-month period. Not applicable. Maximal ankle dorsiflexion range and the presence of abnormal muscle tone affecting the lower limb(s) were evaluated at weekly intervals. Ankle contracture was defined as maximal passive range of less than 0 degrees dorsiflexion with the knee in extension. Patients were grouped into 3 muscle tone categories: normal, predominantly spastic, or predominantly dystonic. Age, sex, mechanism and severity of brain injury, time to onset of ankle contracture, total length of hospital stay, and discharge mobility status data were also recorded. Muscle tone was designated as normal in 68 (64.7%), as spasti...

Purpose: This retrospective audit explored the relationships between Motor Assessment Scale (MAS)... more Purpose: This retrospective audit explored the relationships between Motor Assessment Scale (MAS) scores on admission and patient outcomes including length of stay (LOS), mobility at discharge and discharge destination from an Australian stroke unit. Methods: The dataset included 239 individuals admitted to a stroke rehabilitation unit between June 2001 and January 2007, Associations between variables (admission and discharge scores for

Movement disorders : official journal of the Movement Disorder Society, Jan 15, 2010

Intramuscular injection of botulinum toxin (BoNT) produces reversible blockade of neuromuscular t... more Intramuscular injection of botulinum toxin (BoNT) produces reversible blockade of neuromuscular transmission. In animal experimental models, recovery begins within four weeks and is usually complete by twelve weeks. We present evidence of prolonged denervation following BoNT injection of the vastus lateralis (VL) muscle to correct quadriceps muscle imbalance in patients with chronic anterior knee pain. Needle electromyography data were obtained from 10 subjects who had received a single BoNT treatment 5 to 19 months earlier as part of a clinical trial. Insertional and spontaneous activity, recruitment, and motor unit action potentials were examined. Clear differences between the injected and non-injected VL muscles, which correlated with the time since injection, were identified in all subjects. All 10 subjects studied with needle EMG showed evidence of persisting denervation in the BoNT-A injected VL muscle beyond the period of neuromotor recovery expected from animal experimental ...

European Journal of Neurology, 2010

Disability & Rehabilitation, 2007

Muscle overactivity is common in patients with adult onset central nervous system damage. It can ... more Muscle overactivity is common in patients with adult onset central nervous system damage. It can produce significant disablement in conjunction with other impairments such as adaptive soft tissue shortening and loss of muscle strength. Muscle overactivity is not evenly distributed throughout the body; across joints there is frequently imbalance between agonist and antagonist, producing abnormal joint postures and movement patterns. Due to the asymmetric nature of the abnormal activity across joints, in general we recommend local treatment targeting the more overactive of the two agonists, rather than systemic treatment. Considerable experience with the use of botulinum toxin, both serotypes A and B, in the treatment of muscle overactivity has been accumulated in the last two decades through pragmatic clinical practice and open label studies, supported by an increasing number of randomized controlled trials. In most cases, it is important to use botulinum toxin injection for treatment of muscle overactivity in the setting of wider rehabilitation goals and interventions. Focal and partial blocks with botulinum toxin should be used as a component of a general neurorehabilitation programme rather than as an alternative to other treatments. We review the evidence supporting the use of botulinum toxin to treat muscle overactivity in the lower limb, present practical guidelines on when and how to use botulinum toxin and provide direction for future research.

European Journal of Neurology

Botulinum neurotoxin (BoNT) is most commonly used to reduce focal over-activity in skeletal muscl... more Botulinum neurotoxin (BoNT) is most commonly used to reduce focal over-activity in skeletal muscle, although newer indications such as management of drooling, pain and tremor are emerging. Treatment of spasticity incorporating BoNT is usually part of an integrated multidisciplinary rehabilitation programme. Prior to initiating this therapy, specific functional limitations, goals and expected outcomes of treatment should be discussed with the patient/carers. Muscle selection and the order/priority of treatment should be agreed. Treatment goals may involve increasing active or passive function or the avoidance of secondary complications or impairment progression. This paper describes the basic science mechanisms of the action of BoNT and subsequent nerve recovery and introduces a supplement comprising the best available evidence and expert opinion from international panels on questions of assessment, indications, BoNT regimen, adjunctive therapy, expected outcomes and recommended moni...