ABSTRACT
Background : The aim of this study was to assess the effects of repeated injections of botulinum toxin type A (BoNT-A) combined with a rehabilitative program for treating spastic upper limb hemiparesis after stroke. Subjects and methods: Subjects were 112 poststroke hemiparetic patients with spastic upper limb (mean age : 55.5±11.6 years ±SD, mean period between onset and first injection : 5.1±3.5 years). For each patient, BoNT-A (maximum dose of each injection : 240 units) was injected in the spastic muscles of the affected upper limb twice with a minimum interval of 3 months. Following each injection, detailed one-to-one instructions for homebased functional training was provided. At the baseline (before injection) and at 1 and 3 month follow-ups after each injection, the patient's modified Ashworth scale (MAS), the range of motion (ROM) and Fugl-Meyer Assessment (FMA) were evaluated. Results : The total score for the upper limb and the scores of categories A and B of the FMA increased significantly not only after the first injection but after the second injection compared with the second baseline, while the FMA score for category D increased significantly only after the second injection. MAS also decreased significantly not only after the first injection but after the second injection compared to the second baseline. Conclusion : A more significant improvement was found not only in muscle spasticity but also in upper limb motor function after two BoNT-A injections. It is suggested that repeated BoNT-A injections followed by a comprehensive rehabilitative program would be an effective treatment for limb spasticity after a stroke.
ABSTRACT
We performed a 15 day protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with intensive occupational therapy in hemiplegic upper limbs in poststroke and investigated the effect of cerebral blood flow using single photon emission computed tomography (SPECT). Seventeen chronic stroke patients were studied with SPECT at rest before and 4 weeks after undergoing the 15 day protocol. Before and after the treatment, Fugl-Meyer Assessment (FMA) score and Wolf Motor Function Test (WMFT) -Log performance time showed a significant improvement. The specific areas with a significant increase in perfusion in the affected hemisphere were the insula (BA 13), the precentral gyrus (BA 44) and the cerebellum. In the nonaffected hemisphere, perfusion was significantly increased in the lingual gyrus and cerebellum. On the other hand, perfusion was significantly decreased in the middle frontal gyrus (BA 6), precentral gyrus (BA 4) and postcentral gyrus (BA 3) in the nonaffected hemisphere. It was suggested that low-frequency rTMS combined with intensive occupational therapy effects the cerebral blood flow and contributes to improving upper limb hemiplegia after stroke.
ABSTRACT
To assess the extent of functional gains measured before and after inpatient rehabilitation in patients who have brain tumors, and to identify whether the tumor type, tumor laterality, side of hemiparesis, postoperative addition therapy, cognitive dysfunction, and impairment of consciousness influences outcome. We reviewed the Barthel index(BI)of patients admitted to our hospital from Feb. 2004 to Jan. 2006. Participants numbered 133 persons, aged 52.2±15.4 years old and comprised 57 males and 76 females. All participants had functional impairments resulting from their brain tumors, and patient data was collected from their medical records retrospectively. The numbers of the patients by tumor pathology were 68 gliomas(16 Grade I·II, 52 Grade III·IV), 19 meningiomas, 15 metastatic brain tumors and 31 others. Significant improvements were found between admission and discharge BI scores for all patients, including the glioma group, meningioma group and metastatic tumor group. A significant change of BI improvement was noted between the glioma group and the meningioma group. Length of rehabilitation stay for the glioma group was significantly longer than for the meningioma and metastatic tumor groups. The highest percentage of patients discharged to home was in the glioma group(77.9%). Tumor laterality, side of hemiparesis and postoperative addition therapy all affected functional improvement. We concluded that acute inpatient rehabilitation is an effective treatment for patients with brain tumors that can help them to regain functional ability and to improve their quality of life.