Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan.
Department of Rehabilitaion Medicine, Kikyougahara Hospital, Nagano, Japan.
Disabil Rehabil. 2022 Nov;44(22):6815-6823. doi: 10.1080/09638288.2021.1977394. Epub 2021 Sep 21.
We analysed the effect of botulinum neurotoxin A therapy (BoNT-A) with intensive rehabilitation on the upper limb (UL) spasticity in post-stroke patients by classifying function by UL movement and examining differences in functional improvement.
In this non-randomized, controlled study. The patient function was classified into groups from the score of the sub-categories of the Fugl-Meyer Assessment (FMA-UE) before treatment in the Intervention group by hierarchical cluster analysis.
A total of 139 patients in the Intervention group were classified into six groups. All groups showed a significant improvement in FMA-UE after the intervention. In the group scoring 19-31 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, and finger, a significant improvement was observed compared to the Control group. Further, in the group scoring 26-47 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, wrist, and finger, a significant improvement was observed compared to the Control group.
In this study, BoNT-A and intensive rehabilitation showed improvement in spasticity and UL function. A high therapeutic effect is expected in patients with moderate impairment levels who have voluntary movement in whole UL or in UL except for the wrist.IMPLICATIONS FOR REHABILITATIONHierarchical cluster analysis focusing on the Fugl-Meyer Assessment of the Upper Extremity sub-categories may be useful for studies aimed to improve the upper arm function.Botulinum Neurotoxin A therapy (BoNT-A) and intensive rehabilitation in post-stroke patients showed improvement in spasticity and upper arm function.The degree of the upper arm function before the intervention may affect the improvement effect of BoNT-A and intensive rehabilitation.In the motor function, the post-stroke patients with a moderate impairment level who have voluntary movement of the whole upper limb or upper limb except for the wrist are most likely to receive these therapeutic effects.
我们通过对上肢运动进行分类，分析了脑卒后患者接受肉毒毒素 A 治疗（BoNT-A）结合强化康复治疗对上肢（UL）痉挛的影响，并检查了功能改善的差异。
在这项非随机对照研究中，通过层次聚类分析，根据治疗前 Fugl-Meyer 上肢评估（FMA-UE）子项评分对干预组患者的功能进行分组。
干预组共 139 例患者分为 6 组。所有组在干预后 FMA-UE 均有显著改善。在 FMA-UE 评分为 19-31 分且肩部、肘部、前臂和手指有自主运动的组中，与对照组相比，改善有显著意义。此外，在 FMA-UE 评分为 26-47 分且肩部、肘部、前臂、腕部和手指有自主运动的组中，与对照组相比，改善有显著意义。
本研究表明 BoNT-A 和强化康复可改善痉挛和 UL 功能。对于具有整个 UL 或 UL 除腕部以外的自主运动的中度损伤水平的患者，预计会有较高的治疗效果。
针对上肢 FMA-UE 子项的层次聚类分析可能对改善上臂功能的研究有用。脑卒后患者接受 BoNT-A 和强化康复治疗可改善痉挛和上臂功能。干预前上臂功能的程度可能会影响 BoNT-A 和强化康复的改善效果。在运动功能方面，具有整个上肢或上肢除腕部以外的自主运动的中度损伤水平的脑卒中患者最有可能获得这些治疗效果。
