Uchiyama Yuki, Koyama Tetsuo, Wada Yosuke, Katsutani Masashi, Kodama Norihiko, Domen Kazuhisa
Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan.
J Stroke Cerebrovasc Dis. 2018 Jul;27(7):1975-1986. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.054. Epub 2018 Mar 30.
To examine the effects of botulinum toxin type A (BoNT-A) treatment combined with intensive rehabilitation for gait compared with intensive rehabilitation alone in patients with chronic stroke.
A comparative case series design was used. Subjects were 19 patients with chronic stroke and spastic hemiplegia. In 9 patients (group I), BoNT-A was injected into spastic muscles of the affected lower limbs, followed by a 4-week inpatient intensive rehabilitation program. In the other 10 patients (group II), a 4-week inpatient intensive rehabilitation program alone was first provided (control period) followed by the same treatment protocol in group I. The Modified Ashworth Scale (MAS) scores, range of motion (ROM), gait speed in the 10-Meter Walking Test, 6-Minute Walking Distance Test (6MD) scores, Timed Up and Go Test (TUG) scores, and Berg Balance Scale scores were evaluated every 4 weeks following baseline assessments.
All results except for the MAS score of knee flexor and the ROM of knee flexion improved in group I and the gait speed, 6MD, and TUG scores improved in group II. Intergroup comparisons at week 4 showed significantly greater improvements in the MAS score of ankle plantar flexor, ROM of ankle dorsiflexion, and 6MD in group I than in group II (P = .016, .011, and .009, respectively).
BoNT-A treatment for lower-limb spasticity, combined with intensive rehabilitation, was effective in improving spasticity and the 6MD compared with intensive rehabilitation alone in patients with chronic stroke.
探讨A型肉毒毒素（BoNT-A）治疗联合强化康复训练对慢性脑卒中患者步态的影响，并与单纯强化康复训练进行比较。
采用比较性病例系列设计。研究对象为19例慢性脑卒中伴痉挛性偏瘫患者。9例患者（I组），将BoNT-A注射到患侧下肢痉挛肌肉中，随后进行为期4周的住院强化康复计划。另外10例患者（II组），先单独进行为期4周的住院强化康复计划（对照期），随后采用与I组相同的治疗方案。在基线评估后的每4周，评估改良Ashworth量表（MAS）评分、关节活动度（ROM）、10米步行试验中的步态速度、6分钟步行距离试验（6MD）评分、计时起立行走试验（TUG）评分和Berg平衡量表评分。
I组除膝屈肌MAS评分和膝关节屈曲ROM外的所有结果均有改善，II组的步态速度、6MD和TUG评分有所改善。第4周的组间比较显示，I组踝跖屈肌的MAS评分、踝关节背屈ROM和6MD的改善明显大于II组（P分别为0.016、0.011和0.009）。
对于慢性脑卒中患者，BoNT-A治疗下肢痉挛并联合强化康复训练，与单纯强化康复训练相比，在改善痉挛和6MD方面更有效。
