[ARTICLE] Combined treatment of botulinumtoxin and robot-assisted rehabilitation therapy on poststroke, upper limb spasticity: A case report – Full Text


Rationale: Spasticity is a major complication after stroke, and botulinumtoxin A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve voluntary motor control or activities of daily living function of paretic upper limbs. This study investigated whether BoNT-A injection combined with robot-assisted upper limb therapy improves voluntary motor control or functions of upper limbs after stroke.

Patient concerns: Two subacute stroke patients were transferred to the Department of Rehabilitation.

Diagnoses: Patients demonstrated spasticity in the upper extremity on the affected side.

Interventions: BoNT-A was injected into the paretic muscles of the shoulder, arm, and forearm of the 2 patients at the subacute stage. Conventional rehabilitation therapy and robot-assisted upper limb training were performed during the rehabilitation period.

Outcomes: Manual dexterity, grip strength, muscle tone, and activities of daily living function were improved after multidisciplinary rehabilitation treatment.

Lessons: BoNT-A injection in combination with multidisciplinary rehabilitation treatment, including robot-assisted arm training, should be recommended for subacute spastic stroke patients to enhance appropriate motor recovery.

1 Introduction

Upper limb spasticity is a common complication following stroke, occurring in 20% to 40% of stroke survivors.[1] As upper limb spasticity, joint contractures, and pain limit the voluntary motor control of the arm and hand, the functions of which are essential for the activity of daily living (ADL), ADL dependencies, including hygiene, dressing, and positioning, can be exacerbated.[2]

Injection of botulinumtoxin A (BoNT-A), which is commonly used in the management of focal spasticity in the chronic phase of stroke, reduces muscle tone and passive range of motion. However, it is unclear whether BoNT-A can improve voluntary motor control or ADL functions of upper limbs.[3]

Recently, task-specific high-intensity training with a multidisciplinary team approach has become an important concept in stroke rehabilitation therapy, and robot-assisted arm training (RAT) has been shown to allow well tolerated and intensive task-specific repetitive training of the paretic arm.[4] However, multidisciplinary rehabilitation therapies using RAT in combination with BoNT-A injection have rarely been applied to subacute poststroke spasticity. Thus, we report on 2 cases showing the beneficial effects of RAT in combination with BoNT-A injection on upper limb spasticity in the subacute phase of stroke. […]

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