Abstract
Objective: Using ultrasonography (US) to guide botulinum toxin type A (BTX-A) injection in patients with post-stroke wrist and finger flexor muscle spasticity and assessing clinical outcomes after the injection and rehabilitation intervention.Methods: Twenty-three patients with wrist and finger spasticity after stroke were recruited in this study from May 2012 to May 2013. Under US guidance, the proper dose (250 U) of BTX-A was injected into each spastic muscle at two injection sites. Then, conventional rehabilitation training started next day after BTX-A injection. The degree of spasticity was assessed by modified Ashworth scale (MAS) and wrist and finger motor function by active rang of movement (AROM), and Fugl-Meyer assessment (FMA) at the baseline, 1, 2, 4 and 12 weeks after BTX-A injection.Results: Significant decreases (p < 0.02) in the MAS scores of both the finger flexor muscle tone and wrist flexor muscle tone measured at 1, 2, 4, and 12 weeks after the BTX-A injection were found in comparison with the baseline scores. Compared with the baseline, the AROM values of the wrist and finger extensions and the FMA scores of the wrist and hand significantly increased (p < 0.02) at 2, 4 and 12 weeks after the BTX-A injection.Conclusions: US-guided BTX-A injection combined with rehabilitation exercise decrease spasticity of the wrist and finger flexor muscles and improve their motor function in stroke patients up to 12 weeks following BTX-A injection.
Highlights
Spasticity is a major cause of motor control deficits post stroke
Subjects Post-stroke patients treated in the Department of Rehabilitation Medicine, The Third Affiliated Hospital (TAH), Sun Yat-sen University were recruited from May 2012 to May 2013
The exclusion criteria were as follows: time from stroke onset over 1 year; contracture deformity in the upper limbs; infection at the injection site; oral medication use such as aminoglycoside antibiotics that can disturb the transmission of chemicals in the neuro-muscular junction; unstable medical condition; and severe cognitive disorders, diplegia, pregnancy, breast-feeding, history of BTX-A treatment, and other neurological diseases
Summary
Spasticity is a major cause of motor control deficits post stroke. One-third of stroke patients develop muscle spasticity and these patients often require specific treatment. The spastic posture and deformity of the affected limbs often cause particular function impairment. Frequent flexor spasticity of the upper limb commonly impairs motor function of the hand, especially when the patient intends to open the hand and grasp an object. Patients with a functionless rigid hand have to face many daily living problems such as personal hygiene, eating and dressing. As a result, their quality of life is greatly decreased. One of major goals for poststroke treatment is to reduce spasticity for improved motor function
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