Takekawa Toru, Kakuda Wataru, Taguchi Kensuke, Ishikawa Atsushi, Sase Yousuke, Abo Masahiro
Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Int J Rehabil Res. 2012 Jun;35(2):146-52. doi: 10.1097/MRR.0b013e3283527f4a.
Botulinum toxin type A (BoNT-A) has been reported to be an effective treatment for limb spasticity after stroke. However, the reduction in the spasticity after BoNT-A injection alone does not ensure an improvement in the active motor function of the affected limb. The aim of this study was to clarify the clinical effects of a BoNT-A injection, followed by home-based functional training on not only the passive but also the active motor function of the affected spastic upper limb in poststroke hemiparetic patients. Eighty poststroke patients with spastic upper limb hemiparesis were studied. The severity of hemiparesis was categorized as Brunnstrom stage of 3 for hand-fingers in all patients. BoNT-A (maximum dose of 240 U) was injected into the target muscles of the affected upper limb after a clinical evaluation using the modified Ashworth scale, range of motion, Fugl-Meyer Assessment, and the Wolf Motor Function Test. Following the injection, occupational therapists provided home-based functional training for each patient on a one-to-one basis. The follow-up evaluation was performed 4 weeks after the injection. A significant improvement was found in the modified Ashworth scale and range of motion. The changes in the Fugl-Meyer Assessment and the Wolf Motor Function Test indicated a significant improvement in the active motor function of the affected upper limb. In conclusions, our proposed protocol of a BoNT-A injection, followed by home-based functional training seems to have the potential to improve the active motor function of the affected upper limb after stroke, although the efficacy should be confirmed in a randomized-controlled trial.
据报道，A型肉毒杆菌毒素（BoNT-A）是治疗中风后肢体痉挛的有效方法。然而，仅注射BoNT-A后痉挛的减轻并不能确保受影响肢体的主动运动功能得到改善。本研究的目的是阐明BoNT-A注射联合家庭功能训练对中风后偏瘫患者受影响的痉挛性上肢的被动和主动运动功能的临床效果。对80例中风后上肢痉挛性偏瘫患者进行了研究。所有患者手部手指的偏瘫严重程度均分类为Brunnstrom 3期。在使用改良Ashworth量表、关节活动范围、Fugl-Meyer评估和Wolf运动功能测试进行临床评估后，将BoNT-A（最大剂量240 U）注射到受影响上肢的目标肌肉中。注射后，职业治疗师为每位患者提供一对一的家庭功能训练。注射后4周进行随访评估。改良Ashworth量表和关节活动范围有显著改善。Fugl-Meyer评估和Wolf运动功能测试的变化表明受影响上肢的主动运动功能有显著改善。总之，我们提出的BoNT-A注射联合家庭功能训练方案似乎有可能改善中风后受影响上肢的主动运动功能，尽管其疗效应在随机对照试验中得到证实。
