title: Long-term effects of injection of botulinum toxin type A combined with home-based functional training for post-stroke patients with spastic upper limb hemiparesis.
abstract: The aim of this study was to assess the effects of botulinum toxin type A (BoNT-A) injection with home-based functional training for passive and active motor function, over a 6-month period in post-stroke patients with upper limb spasticity. We studied 190 patients with at least 6-month history of stroke. They received injections of BoNT-A in upper limb muscles and detailed one-to-one instructions for home-based functional training. At baseline (before therapy), and at 1-, 3- and 6-month follow-up, Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT) were used to assess active motor function, the modified Ashworth scale (MAS) for assessment of spasticity, and the range of motion (ROM) for passive motor function. The total score for upper limb and scores of categories A and B of the FMA increased significantly at 1, 3 and 6 months, while the FMA score for category D increased significantly at 3 and 6 months, but not at 1 month. Significant decreases in the MAS scores were noted in all muscles examined at 1, 3 and 6 months, compared with baseline. The ROM for elbow joint extension significantly improved at 1, 3, and 6 months, while that for wrist joint extension increased significantly at 1 month, but not 3 or 6 months, compared with baseline. The results suggest that comprehensive improvement of motor function requires improvement of motor function in the proximal part of the upper limb and that BoNT-A followed by rehabilitation reduces spasticity and improves motor function of fingers.
authors.affiliation: Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Takekawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abo
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Ebihara
authors.forename: Kensuke
authors.initials: K
authors.lastname: Taguchi
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Sase
authors.forename: Wataru
authors.initials: W
authors.lastname: Kakuda
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010291:Paresis / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation*; D020521:Stroke / Q000150:complications / Q000188:drug therapy; D000071939:Stroke Rehabilitation; D013995:Time; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A