title: Combined therapy using botulinum toxin A and single-joint hybrid assistive limb for upper-limb disability due to spastic hemiplegia.
abstract: We investigated the combination of robot-assisted rehabilitation (RT) using a single-joint hybrid assistive limb (HAL-SJ) and botulinum toxin A (BTX-A) as therapy for paretic arm with spasticity in post-stroke patients. Participants were seven patients (4 females, 3 males; mean (±SD) age: 60.6±8.4years) who had spastic hemiplegia following chronic stroke. On the day following BTX-A injection, we started RT, which was performed for 20 sessions of 60min each over a two-week period. Clinical outcome measures, including Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and Disability Assessment Scale (DAS), and cortical activity were evaluated at baseline, and two weeks, and four months following BTX-A injection. Cortical activity associated with elbow joint movement of the affected arm was assessed via functional near infrared spectroscopy (fNIRS). FMA, MAL, and DAS scores significantly improved at two weeks and four months (p<0.05), except DAS scores at four months (p=0.068). The fNIRS study showed that cortical activation increased in the ipsilesional primary sensorimotor area at two weeks and at the four months follow-up. Our pilot study showed that the combination of RT and BTX-A therapy was an effective approach for treating spastic hemiplegia due to stroke, and functional imaging study showed neuroplasticity induced by the treatment.
authors.affiliation: Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan; Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Saita
authors.affiliation: Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan. Electronic address: tmorishita@fukuoka-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Morishita
authors.affiliation: Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hyakutake
authors.affiliation: Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan; Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fukuda
authors.affiliation: Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan.
authors.forename: Etsuji
authors.initials: E
authors.lastname: Shiota
authors.affiliation: Graduate School of Systems and Information Engineering, Center for Cybernics Research, Tsukuba University, Ibaraki, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sankai
authors.affiliation: Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000368:Aged; D001132:Arm / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D026201:Musculoskeletal Manipulations; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D009473:Neuronal Plasticity; D010865:Pilot Projects; D012371:Robotics; D013003:Somatosensory Cortex / Q000000981:diagnostic imaging / Q000378:metabolism; D019265:Spectroscopy, Near-Infrared; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin A; Hybrid assistive limb; Near infrared spectroscopy; Robot-assisted rehabilitation; Spasticity; Stroke