{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:14:44Z","timestamp":1787030084984,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T00:00:00Z","timestamp":1723766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/toxins16080365","type":"journal-article","created":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T12:40:07Z","timestamp":1723812007000},"page":"365","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7131-1168","authenticated-orcid":false,"given":"Pablo","family":"Maldonado","sequence":"first","affiliation":[{"name":"Department of Medical Gerontology, Gier Hospital, 19 rue Laurent Charles, 42400 Saint-Chamond, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9731-6981","authenticated-orcid":false,"given":"Hugo","family":"Bessaguet","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University Hospital of Saint Etienne (CHUSE), Bellevue Hospital, 25 Boulevard Pasteur, 42100 Saint-Etienne, France"},{"name":"Inter-University Laboratory of Human Movement Biology, \u201cPhysical Ability and Fatigue in Health and Disease\u201d Team (F-42023), Saint-Etienne \u201cJean Monnet\u201d, \u201cLyon 1\u201d, \u201cSavoie Mont-Blanc\u201d Universities, 42000 Saint-Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric","family":"Chol","sequence":"additional","affiliation":[{"name":"Department of Medical Gerontology University Hospital of Saint Etienne (CHUSE), Charit\u00e9 Hospital, 44 Rue Pointe Cadet, 42100 Saint-Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8581-1472","authenticated-orcid":false,"given":"Pascal","family":"Giraux","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University Hospital of Saint Etienne (CHUSE), Bellevue Hospital, 25 Boulevard Pasteur, 42100 Saint-Etienne, France"},{"name":"Lyon Neuroscience Research Center, Trajectoires Team (Inserm UMR-S 1028, CNRS UMR 5292, Lyon 1 and Saint-Etienne Universities), 42270 Saint-Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovic","family":"Lafaie","sequence":"additional","affiliation":[{"name":"Department of Medical Gerontology University Hospital of Saint Etienne (CHUSE), Charit\u00e9 Hospital, 44 Rue Pointe Cadet, 42100 Saint-Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Adham","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University Hospital of Saint Etienne (CHUSE), Bellevue Hospital, 25 Boulevard Pasteur, 42100 Saint-Etienne, France"},{"name":"Lyon Neuroscience Research Center, Trajectoires Team (Inserm UMR-S 1028, CNRS UMR 5292, Lyon 1 and Saint-Etienne Universities), 42270 Saint-Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"David","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France"},{"name":"PRISMATICS Laboratory (Predictive Research in Spine\/Neuromodulation Management and Thoracic Innovation\/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Celarier","sequence":"additional","affiliation":[{"name":"Department of Medical Gerontology University Hospital of Saint Etienne (CHUSE), Charit\u00e9 Hospital, 44 Rue Pointe Cadet, 42100 Saint-Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3413-4341","authenticated-orcid":false,"given":"Etienne","family":"Ojardias","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University Hospital of Saint Etienne (CHUSE), Bellevue Hospital, 25 Boulevard Pasteur, 42100 Saint-Etienne, France"},{"name":"Lyon Neuroscience Research Center, Trajectoires Team (Inserm UMR-S 1028, CNRS UMR 5292, Lyon 1 and Saint-Etienne Universities), 42270 Saint-Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jamda.2021.05.036","article-title":"Factors Associated with Development of New Joint Contractures in Long-Term Care Residents","volume":"23","author":"Lam","year":"2022","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.rehab.2018.10.005","article-title":"Joint Contractures and Acquired Deforming Hypertonia in Older People: Which Determinants?","volume":"62","author":"Dehail","year":"2019","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.rehab.2013.11.001","article-title":"Acquired Deforming Hypertonia and Contractures in Elderly Subjects: Definition and Prevalence in Geriatric Institutions (ADH Survey)","volume":"57","author":"Dehail","year":"2014","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jamda.2009.04.010","article-title":"Contractures in Nursing Home Residents","volume":"11","author":"Wagner","year":"2010","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s00391-015-0895-y","article-title":"Impact of Joint Contracture on Older Persons in a Geriatric Setting: A Cross-Sectional Study","volume":"48","author":"Bartoszek","year":"2015","journal-title":"Z. Gerontol. Geriatr."},{"key":"ref_6","first-page":"269","article-title":"Prevalence of Functioning and Disability in Older Patients with Joint Contractures: A Cross-Sectional Study","volume":"51","author":"Fischer","year":"2015","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1519\/00139143-200608000-00002","article-title":"Paratonia: A Delphi Procedure for Consensus Definition","volume":"29","author":"Hobbelen","year":"2006","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14802\/jmd.13001","article-title":"New Perspective on Parkinsonism in Frontotemporal Lobar Degeneration","volume":"6","author":"Park","year":"2013","journal-title":"J. Mov. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2548","DOI":"10.1007\/s00415-015-7886-1","article-title":"Pattern of Extrapyramidal Signs in Alzheimer\u2019s Disease","volume":"262","author":"Tosto","year":"2015","journal-title":"J. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1017\/S1041610210002449","article-title":"Prevalence, Incidence and Risk Factors of Paratonia in Patients with Dementia: A One-Year Follow-up Study","volume":"23","author":"Hobbelen","year":"2011","journal-title":"Int. Psychogeriatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/JGP.0b013e31802ea907","article-title":"Prevalence and Impact of Paratonia in Alzheimer Disease in a Multiracial Sample","volume":"15","author":"Vahia","year":"2007","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1016\/S0003-9993(99)90328-3","article-title":"Extent and Direction of Joint Motion Limitation after Prolonged Immobility: An Experimental Study in the Rat","volume":"80","author":"Trudel","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"655","DOI":"10.2147\/CIA.S248602","article-title":"A Simple Bedside Screening Tool for Spasticity Referral","volume":"15","author":"Hacker","year":"2020","journal-title":"Clin. Interv. Aging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jamda.2014.10.005","article-title":"Ultrasound and Electrical Stimulator-Guided Obturator Nerve Block With Phenol in the Treatment of Hip Adductor Spasticity in Long-Term Care Patients: A Randomized, Triple Blind, Placebo Controlled Study","volume":"16","author":"Lam","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"482","DOI":"10.2340\/16501977-2239","article-title":"Practice Patterns for Spasticity Management with Phenol Neurolysis","volume":"49","author":"Karri","year":"2017","journal-title":"J. Rehabil. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.npg.2019.03.003","article-title":"Efficacit\u00e9 de l\u2019alcoolisation du nerf obturateur dans l\u2019hypertonie des adducteurs chez la personne \u00e2g\u00e9e hospitalis\u00e9e: \u00c9tude pr\u00e9liminaire","volume":"19","author":"Brunet","year":"2019","journal-title":"NPG Neurol. Psychiatr. G\u00e9riatrie"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101839","DOI":"10.1016\/j.rehab.2024.101839","article-title":"Percutaneous Needle Tenotomies: Indications, Procedures, Efficacy and Safety. A Systematic Review","volume":"67","author":"Bessaguet","year":"2024","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_18","first-page":"17","article-title":"Botulinum toxin in the elderly to the care of limbs spastic hypertonia and toes or fingers dystonias","volume":"10","author":"Chol","year":"2012","journal-title":"Geriatr. Psychol. Neuropsychiatr. Vieil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"484","DOI":"10.31128\/AJGP-12-21-6279","article-title":"Role of Botulinum Toxin in the Management of Hand Ulceration Due to Post-Stroke Spasticity among Aged Care Residents","volume":"51","author":"Eyre","year":"2022","journal-title":"Aust. J. Gen. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.jamda.2012.03.005","article-title":"Can Botulinum Toxin Decrease Carer Burden in Long Term Care Residents with Upper Limb Spasticity? A Randomized Controlled Study","volume":"13","author":"Lam","year":"2012","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_21","unstructured":"Haute Autorit\u00e9 de Sant\u00e9 (HAS) (2024, July 14). Les Anticoagulants Oraux; Saint-Denis La Plaine. Available online: https:\/\/www.has-sante.fr\/jcms\/c_2851086\/fr\/les-anticoagulants-oraux."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101467","DOI":"10.1016\/j.rehab.2020.101467","article-title":"Management of Antithrombotics for Intramuscular Injection of Botulinum Toxin for Spasticity. A Survey of Real-Life Practice in France","volume":"64","author":"Ble","year":"2021","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Levy, J., Karam, P., Forestier, A., Loze, J.-Y., and Bensmail, D. (2023). Botulinum Toxin Use in Patients with Post-Stroke Spasticity: A Nationwide Retrospective Study from France. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1245228"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1177\/0269215519859621","article-title":"Prevalence of Unmet Needs for Spasticity Management in Care Home Residents in the East Midlands, United Kingdom: A Cross-Sectional Observational Study","volume":"33","author":"Edwards","year":"2019","journal-title":"Clin. Rehabil."},{"key":"ref_25","unstructured":"M\u00e9dina, M. (2024, July 14). Utilisation de la Toxine Botulique dans la Prise en Charge de la Spasticit\u00e9 des Personnes \u00e2g\u00e9es. Available online: https:\/\/dumas.ccsd.cnrs.fr\/dumas-01068753v1\/file\/Med_generale_2014_Medina.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s12612-010-0049-1","article-title":"L\u2019AVC du sujet \u00e2g\u00e9: Vers une prise en charge sp\u00e9cialis\u00e9e \u00e0 la phase aigu\u00eb et en SSR?","volume":"2","author":"Guilhermet","year":"2010","journal-title":"Les Cahiers de l\u2019ann\u00e9e G\u00e9rontologique"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"101690","DOI":"10.1016\/j.rehab.2022.101690","article-title":"Microinvasive Percutaneous Needle Tenotomy, An Alternative to Open Surgery to Treat Neurological Foot Deformities","volume":"66","author":"Angioni","year":"2022","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kleiner-Fisman, G., Khoo, E., Moncrieffe, N., Forbell, T., Gryfe, P., and Fisman, D. (2014). A Randomized, Placebo Controlled Pilot Trial of Botulinum Toxin for Paratonic Rigidity in People with Advanced Cognitive Impairment. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0114733"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Schnitzler, A., Dince, C., Freitag, A., Iheanacho, I., Fahrbach, K., Lavoie, L., Loze, J.-Y., Forestier, A., and Gasq, D. (2022). AbobotulinumtoxinA Doses in Upper and Lower Limb Spasticity: A Systematic Literature Review. Toxins, 14.","DOI":"10.3390\/toxins14110734"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"101579","DOI":"10.1016\/j.rehab.2021.101579","article-title":"Time Course Response after Single Injection of Botulinum Toxin to Treat Spasticity after Stroke: Systematic Review with Pharmacodynamic Model-Based Meta-Analysis","volume":"65","author":"Ojardias","year":"2022","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1002\/(SICI)1097-4598(199604)19:4<488::AID-MUS9>3.0.CO;2-8","article-title":"Extrafusal and Intrafusal Muscle Effects in Experimental Botulinum Toxin-A Injection","volume":"19","author":"Rosales","year":"1996","journal-title":"Muscle Nerve"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S0021-5155(99)00197-5","article-title":"Presynaptic Effects of Botulinum Toxin Type A on the Neuronally Evoked Response of Albino and Pigmented Rabbit Iris Sphincter and Dilator Muscles","volume":"44","author":"Ishikawa","year":"2000","journal-title":"Jpn. J. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"21338","DOI":"10.1016\/S0021-9258(19)36614-1","article-title":"Tetanus Toxin and Botulinum Toxins Type A and B Inhibit Glutamate, Gamma-Aminobutyric Acid, Aspartate, and Met-Enkephalin Release from Synaptosomes. Clues to the Locus of Action","volume":"267","author":"McMahon","year":"1992","journal-title":"J. Biol. Chem."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Popescu, M.N., Beiu, C., Iliescu, M.G., Mihai, M.M., Popa, L.G., St\u0103nescu, A.M.A., and Berteanu, M. (2022). Botulinum Toxin Use for Modulating Neuroimmune Cutaneous Activity in Psoriasis. Medicina, 58.","DOI":"10.3390\/medicina58060813"},{"key":"ref_35","unstructured":"Match ID (2024, April 26). National Public Death Database. Available online: https:\/\/deces.matchid.io\/search."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.annrmp.2005.04.005","article-title":"\u00c9valuation de l\u2019autonomie de la personne \u00e2g\u00e9e","volume":"48","author":"Benaim","year":"2005","journal-title":"Ann. De R\u00e9adaptation Et De M\u00e9decine Phys."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejim.2016.03.007","article-title":"Frailty Measurement in Research and Clinical Practice: A Review","volume":"31","author":"Dent","year":"2016","journal-title":"Eur. J. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1177\/0269215508101742","article-title":"Goal Attainment Scaling (GAS) in Rehabilitation: A Practical Guide","volume":"23","year":"2009","journal-title":"Clin. Rehabil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"jrm6498","DOI":"10.2340\/jrm.v55.6498","article-title":"Goal Attainment Scaling in Rehabilitation: An Educational Review Providing a Comprehensive Didactical Tool Box for Implementing Goal Attainment Scaling","volume":"55","author":"Villepinte","year":"2023","journal-title":"J. Rehabil. Med."},{"key":"ref_40","unstructured":"Kiresuk, T.J., Smith, A., and Cardillo, J.E. (1994). Goal Attainment Scaling: Applications, Theory, and Measurement, L. Erlbaum Associates."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.rehab.2013.02.002","article-title":"Goal Attainment Scaling in Rehabilitation: A Literature-Based Update","volume":"56","author":"Hiebel","year":"2013","journal-title":"Ann. Phys. Rehabil. Med."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/16\/8\/365\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:37:55Z","timestamp":1760110675000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/16\/8\/365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,16]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["toxins16080365"],"URL":"https:\/\/doi.org\/10.3390\/toxins16080365","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,16]]}}}