title: Mobility and gait outcomes following intensive rehabilitation, onabotulinumtoxin A, and baclofen treatment chronic post-stroke: a case report.
abstract: PURPOSE. This case report describes the effects of intensive rehabilitation with systemic antispasticity and local neurotoxin pharmacological interventions on gait and activity outcomes for a patient with chronic impairments post-stroke. CASE DESCRIPTION. The 56-year-old male patient was 13 months post-stroke with left hemiparesis and hypertonicity in the left upper and lower extremities. The patient received oral baclofen for widespread hypertonicity and intramuscular onabotulinumtoxin A injections in muscles of the left upper and lower extremities to target local areas of hypertonicity. The patient received weight-supported treadmill training, over-ground gait training, neuromuscular re-education, and balance training three times per week during 20 of the 25 weeks of the study period. OUTCOMES. The patient demonstrated improvements in balance (Berg Balance Scale), mobility (Timed Up and Go test), and motor function (Stroke Rehabilitation Assessment of Movement Measure). Kinematic measures of gait also improved in ankle and knee range of motion during both stance and swing phases. DISCUSSION. This case demonstrates that improvements in impairment and activity outcomes can occur in an individual with significant post-stroke chronic impairments after receiving intensive physical therapy in conjunction with pharmacologic interventions to control hypertonicity. The persistence and generalizability of these results need to be determined.
authors.affiliation: Dep. of Physical Therapy, CSU Sacramento, 6000 J Street, Sacramento, CA 95819-6020, USA. Tel 916-278-5054, fax 916-278-6842. barakatt@csus.edu.
authors.forename: Edward
authors.initials: E
authors.lastname: Barakatt
authors.forename: Bryan
authors.initials: B
authors.lastname: Coleman-Salgado
authors.forename: Michael
authors.initials: M
authors.lastname: McKeough
authors.forename: David
authors.initials: D
authors.lastname: Mandeville
authors.forename: Jillian
authors.initials: J
authors.lastname: Gong
authors.forename: Emily
authors.initials: E
authors.lastname: Mintz
authors.forename: Joshua
authors.initials: J
authors.lastname: Thatch
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vourakis
authors.forename: Nicklesh
authors.initials: N
authors.lastname: Thakur
mesh_terms: D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009122:Muscle Hypertonia / Q000628:therapy; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D000071939:Stroke Rehabilitation / Q000379:methods*
chemical_list: D009125:Muscle Relaxants, Central; D019274:Botulinum Toxins, Type A; D001418:Baclofen