{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:07:32Z","timestamp":1777532852041,"version":"3.51.4"},"reference-count":28,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2013,8,14]],"date-time":"2013-08-14T00:00:00Z","timestamp":1376438400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Rehabil"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To compare the outcome of manual needle placement, electrical stimulation and ultrasonography-guided techniques for botulinum toxin injection into the forearm muscles of adults with arm spasticity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>University hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects:<\/jats:title>\n                    <jats:p>Sixty chronic stroke patients with wrist and fingers spasticity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention:<\/jats:title>\n                    <jats:p>After randomization into three groups, each patient received botulinum toxin type A in at least two of these muscles: flexor carpi radialis and ulnaris, flexor digitorum superficialis and profundus (no fascicles selection). The manual needle placement group underwent injections using palpation; the electrical stimulation group received injections with electrical stimulation guidance; the ultrasonography group was injected under sonographic guidance. A sole injector was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main measures:<\/jats:title>\n                    <jats:p>All patients were evaluated at baseline and four weeks after injection. Outcomes: Modified Ashworth Scale; Tardieu Scale; wrist and fingers passive range of motion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>One month after injection, Modified Ashworth Scale scores improved more in the electrical stimulation group than the manual needle placement group (wrist: P = 0.014; fingers: P = 0.011), as well as the Tardieu angle (wrist: P = 0.008; fingers: P = 0.015) and passive range of motion (wrist: P = 0.004). Furthermore, Modified Ashworth Scale scores improved more in the ultrasonography group than in the manual needle placement group (wrist: P = 0.001; fingers: P = 0.003), as well as the Tardieu angle (wrist: P = 0.010; fingers: P = 0.001) and passive range of motion (wrist: P &lt; 0.001; proximal interphalangeal joints: P = 0.009). No difference was found between the ultrasonography and electrical stimulation groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Instrumental guidance may improve the outcome of botulinum toxin injections into the spastic forearm muscles of stroke patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0269215513497735","type":"journal-article","created":{"date-parts":[[2013,8,15]],"date-time":"2013-08-15T06:15:34Z","timestamp":1376547334000},"page":"232-242","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":76,"title":["Botulinum toxin injection into the forearm muscles for wrist and fingers spastic overactivity in adults with chronic stroke: a randomized controlled trial comparing three injection techniques"],"prefix":"10.1177","volume":"28","author":[{"given":"Alessandro","family":"Picelli","sequence":"first","affiliation":[{"name":"Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy"},{"name":"University of Rome \u2018La Sapienza\u2019, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Lobba","sequence":"additional","affiliation":[{"name":"Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Midiri","sequence":"additional","affiliation":[{"name":"Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Prandi","sequence":"additional","affiliation":[{"name":"Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilla","family":"Melotti","sequence":"additional","affiliation":[{"name":"Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Baldessarelli","sequence":"additional","affiliation":[{"name":"Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Smania","sequence":"additional","affiliation":[{"name":"Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy"},{"name":"Neurological Rehabilitation Unit, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,8,14]]},"reference":[{"key":"bibr1-0269215513497735","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.69.2.217"},{"key":"bibr2-0269215513497735","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000258077.88064.a3"},{"key":"bibr3-0269215513497735","first-page":"349","volume":"45","author":"Smania N","year":"2009","journal-title":"Eur J Phys Rehabil Med"},{"key":"bibr4-0269215513497735","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.572065"},{"key":"bibr5-0269215513497735","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0366"},{"key":"bibr6-0269215513497735","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000311391.00944.c4"},{"key":"bibr7-0269215513497735","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0303"},{"key":"bibr8-0269215513497735","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/67.2.206"},{"key":"bibr9-0269215513497735","unstructured":"Dallal G. 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