A型肉毒杆菌毒素联合神经动力松动术治疗中风后上肢痉挛：一例报告
Botulinum toxin type A combined with neurodynamic mobilization for upper limb spasticity after stroke: a case report.
作者信息
Villafañe Jorge H, Silva Guillermo B, Chiarotto Alessandro, Ragusa Orazio L F
机构信息
Physical Therapist, Department of Physical Therapy, Residenze Sanitarie Assistenziali "A. Maritano," Sangano, Italy ; Physical Therapist, Private Practitioner, Turin, Italy.
出版信息
J Chiropr Med. 2012 Sep;11(3):186-91. doi: 10.1016/j.jcm.2012.05.009.
OBJECTIVE
The purpose of this study is to report a case in which combinatory therapy of botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM) was used as treatment for a patient with severe upper limb spasticity and pain after stroke.
CLINICAL FEATURES
A 76-year-old male patient had spastic muscles in the upper limb 10 months after an ischemic stroke.
INTERVENTION AND OUTCOME
The patient underwent combined treatment with BoNT-A and NM of the upper limb in 6 monthly applications. Evaluation was performed pretreatment, 3 months after the first injection, 3 months after the second injection, and at a follow-up session 9 months after starting the treatment. The following outcomes were measured: pain by using a numeric rating scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. The patient improved in all outcomes after treatment, and results were maintained during the follow-up sessions.
CONCLUSION
The combined NM and BoNT-A treatment appeared to decrease pain and improve joint ranges of motion during treatment for this patient. The patient showed decreased anxiety and depression during and after the treatment.
目的
本研究旨在报告一例采用A型肉毒毒素（BoNT-A）与神经动力松动术（NM）联合治疗卒中后严重上肢痉挛和疼痛患者的病例。
临床特征
一名76岁男性患者在缺血性卒中10个月后出现上肢肌肉痉挛。
干预与结果
患者接受了6次每月一次的上肢BoNT-A与NM联合治疗。在治疗前、首次注射后3个月、第二次注射后3个月以及开始治疗9个月后的随访阶段进行评估。测量以下结果：使用数字评分量表评估疼痛，使用改良Ashworth痉挛分级量表评估痉挛，使用医院焦虑抑郁量表评估对治疗的接受程度和情绪反应，以及通过关节活动范围评估功能。治疗后患者在所有结果方面均有改善，且在随访期间结果得以维持。
结论
对于该患者，NM与BoNT-A联合治疗在治疗期间似乎减轻了疼痛并改善了关节活动范围。患者在治疗期间及治疗后焦虑和抑郁程度降低。
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