After 17 years of interviewing doctors and others on the frontline treating stroke patients, I am realizing I’ve missed an important “quality of life” issue. I’ve been so focused on covering how patients can recover brain function and prevent additional strokes that I haven’t been covering the “arm problem.”

THE ARM PROBLEM

Technically it’s called upper limb spasticity when the patient has a stiff, twisted arm and clenched hand. Patients say it’s painful and a huge hindrance when it comes to daily tasks like getting dressed or using the toilet.
While interviewing Angelo Termine, CEO of New England Institute for Clinical Research (NEICR), I learned just how much better life can get for a stroke patient if that arm problem is alleviated.
Termine describes one stroke patient who was pretty bitter about his “stroke after effects” when he showed up at NEICR to enroll in a clinical trial for injections of a neurotoxin. After two injections in his arm, the man’s arm muscles relaxed, and his hand opened up… along with his optimism.
  The patient said to Termine,
“I can’t recall the last time I felt this good.”
Since this was during the clinical trial, Termine didn’t even know if the patient got the neurotoxin or a placebo. But clearly, something had gone very right for this patient.
Once the clinical trial wrapped up and the data was released, it was clear that the patient was on the neurotoxin that went on to get FDA approval and is now on the market as Xeomin.

FDA APPROVED INJECTIONS

Dr. Peter McAllister, of New England Institute for Neurology & Headache (NEINH), says Xeomin, Botox, Dysport and Myobloc are all neurotoxins on the market used for this issue.  “They’re injected with a small needle into the very tight muscles, and what happens is the medicine goes down to where the nerve connects to the muscle and it causes the muscle to relax. After a week or so, you are able to loosen that up,” he says.
With 800,000 new cases of stroke every year and many patients left with this imbalance of signals from the brain to the arm muscles, Dr. McAllister wants patients to know they’re not necessarily stuck with it. Clinical studies of Xeomin found 3 out of 4 patients experienced some improvement of the problem and 43 percent experienced marked improvement.
“What we found was the Xeomin injected into the muscles caused the muscles to loosen up, caused the fingers to come out of the palm, caused the pain to go down and gave the patient more sense of what they were kind of like before the stroke and brain injury,” says Dr. McAllister.
Physical therapy and occupational therapy have also played a role in alleviating upper limb spasticity for this stroke patient and others. Dr. McAllister’s wife physical therapist Caryn McAllister, DPT, who heads up NEINH’s High Quality Home Therapy, says when a patient has this issue their arm is twisted, bent and basically stuck. “When I see a patient with upper limb spasticity, I typically assess first for pain and then I look at function,” says Caryn McAllister. She says they work to stretch the limb, strengthen the arm muscles including the muscles that are opposite the ones that are contracted, train the patient to take care of daily tasks like brushing their teeth and work on gait training. “We want the arm to be swinging so the trunk rotates and their gait is more normalized. People feel more comfortable, more balanced and less pain.”

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