title: Therapeutic synergism in the treatment of post-stroke arm paresis utilizing botulinum toxin, robotic therapy, and constraint-induced movement therapy.
abstract: Botulinum toxin type A (BtxA) injection, constraint-induced movement therapy (CIMT), and robotic therapy (RT) each represent promising approaches to enhance arm motor recovery after stroke. To provide more effective treatment for a 50-year-old man with severe left spastic hemiparesis, we attempted to facilitate CIMT with adaptive approaches to extend the wrist and fingers using RT for 10 consecutive weeks after BtxA injection. This combined treatment resulted in substantial improvements in arm function and the amount of arm use in activities of daily living, and may be effective for stroke patients with severe arm paresis. However, we were unable to sufficiently prove the efficacy of combined treatment based only on a single case. To fully elucidate the efficacy of the combined approach for patients with severe hemiparesis after stroke, future studies of a larger number of patients are needed.
authors.affiliation: Department of Rehabilitation, The Hospital of Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan∗. Electronic address: takshi77@hyo-med.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Takebayashi
authors.affiliation: Department of Rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan(†).
authors.forename: Satoru
authors.initials: S
authors.lastname: Amano
authors.affiliation: Department of Rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan(‡).
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hanada
authors.affiliation: Department of Rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan(§).
authors.forename: Atsushi
authors.initials: A
authors.lastname: Umeji
authors.affiliation: Department of Allied Health Science, Kitasato University, Sagamihara, Kanagawa, Japan(‖).
authors.forename: Kayoko
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan(¶).
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan(#).
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Domen
mesh_terms: D000203:Activities of Daily Living; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A