A Pilot Randomized Controlled Trial of Botulinum Toxin Treatment Combined with Robot-Assisted Therapy, Mirror Therapy, or Active Control Treatment in Patients with Spasticity Following Stroke

Jen-Wen Hung; Chu-Ling Yen; Ku-Chou Chang; Wei-Chi Chiang; I-Ching Chuang; Ya-Ping Pong; Wen-Chi Wu; Ching-Yi Wu

doi:10.3390/toxins14060415

A Pilot Randomized Controlled Trial of Botulinum Toxin Treatment Combined with Robot-Assisted Therapy, Mirror Therapy, or Active Control Treatment in Patients with Spasticity Following Stroke

Toxins (Basel). 2022 Jun 17;14(6):415. doi: 10.3390/toxins14060415.

Authors

Jen-Wen Hung^{1

2}, Chu-Ling Yen^{3

4

5}, Ku-Chou Chang^{2

6

7

8}, Wei-Chi Chiang^{3

9}, I-Ching Chuang^{3

10

11}, Ya-Ping Pong^{1

2}, Wen-Chi Wu¹, Ching-Yi Wu^{3

11

12}

Affiliations

¹ Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan.
² School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
³ Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
⁴ School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
⁵ Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan.
⁶ Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan.
⁷ Discharge Planning Service Center, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan.
⁸ Department of Senior Citizen Service Management, Yuh-Ing Junior College, Kaohsiung 80776, Taiwan.
⁹ Department of Occupational Therapy, I-Shou University, Kaohsiung 82445, Taiwan.
¹⁰ Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan.
¹¹ Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan.
¹² Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan.

Abstract

Effects of the combined task-oriented trainings with botulinum toxin A (BoNT-A) injection on improving motor functions and reducing spasticity remains unclear. This study aims to investigate effects of 3 task-oriented trainings (robot-assisted therapy (RT), mirror therapy (MT), and active control treatment (AC)) in patients with stroke after BoNT-A injection. Thirty-seven patients with chronic spastic hemiplegic stroke were randomly assigned to receive RT, MT, or AC following BoNT-A injection over spastic upper extremity muscles. Each session of RT, MT, and AC was 75 min, 3 times weekly, for 8 weeks. Outcome measures were assessed at pretreatment, post-treatment, and 3-month follow-up, involving the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), including amount of use (AOU) and quality of movement (QOM), and arm activity level. All 3 combined treatments improved FMA, MAS, and MAL. The AC induced a greater effect on QOM in MAL at the 3-month follow-up than RT or MT. All 3 combined trainings induced minimal effect on arm activity level. Our findings suggest that for patients with stroke who received BoNT-A injection over spastic UE muscles, the RT, MT, or AC UE training that followed was effective in improving motor functions, reducing spasticity, and enhancing daily function.

Keywords: conventional rehabilitation; mirror therapy; motor function; robot-assisted training; stroke rehabilitation; upper extremity.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Botulinum Toxins, Type A* / therapeutic use
Humans
Mirror Movement Therapy
Muscle Spasticity / drug therapy
Muscle Spasticity / etiology
Pilot Projects
Robotics*
Stroke Rehabilitation*
Stroke* / complications
Stroke* / drug therapy
Treatment Outcome
Upper Extremity

Substances

Botulinum Toxins, Type A

Grants and funding

This work was supported by the Ministry of Science and Technology in Taiwan under 105-2314-B-182A-085, 106-2314-B-182A-121, and 109-2314-B-182-027-MY3; Chang Gung Memorial Hospital under BMRP553, CMRPG8E0931, CMRPD1I-0031, and CMRPD1M0041; National Health Research Institutes under NHRI-EX111-11105PI.