Comprehensive Rehabilitation Therapy of Traditional Chinese Medicine Combined with Modern Rehabilitation Training Improves the Spasticity and Motor Function of Hemiplegia after Stroke

Objective:To analyze the impact of comprehensive rehabilitation therapy of traditional Chinese medicine(TCM)(based on modern rehabilitation training)on the spasticity and motor function in stroke patients with hemiplegia.Methods:Seventy-nine stroke and hemiplegia patients admitted to the hospital from June 2021 to June 2023 were selected and randomly divided into a control group(39 cases)using modern rehabilitation training,and an observation group combined with comprehensive TCM rehabilitation therapy(40 cases),over 1 month.The clinical index data of the two groups were compared.Results:There were differences in the clinical index data between the two groups.The total effective rate after 2 treatment in the observation group(92.50%)was higher than that of the control group(74.36%)(χ^(2)=4.727,P<0.05).All central sensitization inventory(CSI)and stroke quality of life(PRO)scores in both groups were lower after treatment,with the observation group having lower scores as compared to the control group(P<0.05).The scores of FMA(upper limbs,lower limbs),Barthel index scores,and Functional Ambulation Categories(FAC)scores of both groups increased after treatment,with the observation group having higher scores as compared to the control group(P<0.05).Conclusion:Comprehensive TCM rehabilitation therapy had a significant therapeutic effect on patients with hemiplegia after stroke.It improved the patient’s spasticity,limb movement,and walking function.Their daily living abilities and quality of life were also enhanced.

An overview of acupuncture for the treatment of limb spasticity in cerebral palsy-A mini review

Cerebral palsy is a common chronic disabling disease in children with special needs,and rehabilitation for cerebral palsy is characterized by a long period,multiple methods and limited efficacy.Due to the limited motor function of cerebral palsy patients,the quality of life of patients is reduced,and their ability to participate in society is reduced,so the improvement of patients’motor function has become an important goal of cerebral palsy rehabilitation.The motor function of cerebral palsy has become an important goal of cerebral palsy rehabilitation.Limb spasticity is one of the main clinical signs of cerebral palsy patients,and the more severe the limb spasticity is,the greater the impact on the patient's motor function,so improving limb spasticity in patients with cerebral palsy is particularly important.Acupuncture,as a Chinese medicine treatment method,has been widely used in the clinical treatment of cerebral palsy in China,and has shown certain efficacy.To promote the clinical application of acupuncture technique in cerebral palsy limb spasticity,this paper analyses and summarizes the relevant literature on acupuncture treatment of cerebral palsy limb spasticity summarizes the current status of the clinical application of acupuncture in cerebral palsy limb spasticity,and provides clinical references for the reasonable application of acupuncture in cerebral palsy limb spasticity.

Association between brain N-acetylaspartate levels and sensory and motor dysfunction in patients who have spinal cord injury with spasticity:an observational case-control study

Spinal cord injury is a severe and devastating disease,and spasticity is a common and severe complication that is notoriously refractory to treatment.However,the pathophysiological mechanisms underlying spasticity and its development remain largely unknown.The goal of the present study was to find differences,if any,in metabolites of the left precentral gyrus and basal ganglia of patients who have spinal cord injury with or without spasticity,and to explore the relationship between the brain metabolite concentrations and clinical status.Thirty-six participants were recruited for magnetic resonance spectroscopic examination:23 with spinal cord injury(12 with spasticity and 11 without spasticity)and 13 healthy controls.We acquired localized proton spectra from the precentral gyrus and basal ganglia via 10 mm^(3) voxels.Notably,univariate linear regression analysis demonstrated that the lower that the N-acetylaspartate concentration(a marker for neuronal loss)was in the precentral gyrus of the patients,the lower their ASIA(American Spinal Injury Association)light-touch scores,pinprick scores,and motor scores.Additionally,longer durations of injury were associated with higher N-acetylaspartate levels in the precentral gyrus.Compared with the healthy participants and patients without spasticity,N-acetylaspartate levels in the patients with spasticity were significantly lower in both the precentral gyrus and basal ganglia.Lower N-acetylaspartate levels also correlated with greater sensory and motor dysfunction in the patients who had spinal cord injury with spasticity.

Extracorporeal shock wave for plantar flexor spasticity in spinal cord injury:A case report and review of literature

BACKGROUND Approximately 65%-78%of patients with a spinal cord injury(SCI)develop any symptom of spasticity.The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal shock wave therapy(r ESWT)on plantar flexor spasticity in a patient with incomplete SCI.CASE SUMMARY An 18-year-old man with an incomplete SCI completed five sessions of r ESWT.The primary outcomes were the changes in ankle-passive range of motion(APROM)and passive resistive force to ankle dorsiflexion.The outcomes were assessed at baseline(T0),immediately after treatment(T1)and 1 wk after the end of treatment(T2).The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0.The passive resistive force to ankle dorsiflexion at low velocity decreased by 33%at T1 and 55%at T2 in the gastrocnemius muscle and by 41%at T1 and 39%at T2 in the soleus muscle compared with T0.At high velocity,it also decreased by 44%at T1 and 30%at T2 in the gastrocnemius muscle compared with T0.However,in the soleus muscle,the change was minor,with a decrease of 12%at T1 and increased by 39%at T2 compared with T0.CONCLUSION In this patient,the findings showed that r ESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term.Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.

Expression of DRD1 mRNA after Spinal Cord Injury Induced Spasticity in Rats

[Objectives]To investigate the spasticity of rat tail and the expression of dopamine receptor-1(DRD1)mRNA in the spinal cord after spinal cord injury(SCI)induced tail spasticity in rats.[Methods]Adult male Wistar rats were randomly divided into Sham group and SCI group.The second sacral spinal cord(S2)segment of SCI rats was completely transected.60 d after operation,the rat tail spasticity was scored,and then the spinal cord tissues below the level of S2 spinal cord transection were taken.The expression of DRD1 mRNA in the sacrococcygeal spinal cord was detected by qPCR.In addition,3 normal rats were used for DAR/neuronal nuclei(NeuN)and DRD1/choline acetyltransferase(ChAT)immunofluorescence staining to study the distribution of DRD1 in spinal cord and the properties of DRD1 positive cells.[Results]60 d after operation in SCI group,the tail spasticity of rats developed fully,and the symptoms of spasticity were typical.qPCR results showed that the expression of DRD1 mRNA in SCI group was significantly lower than that in Sham group(P<0.05).DRD1 was widely distributed in the dorsal horn,intermediate zone and ventral horn at the sacrococcygeal end of the rat spinal cord.[Conclusions]The decrease of DRD1 mRNA expression after SCI may be related to the occurrence and development of spasticity.

Effects of Microselective Neurotomy on Focal Spasticity and Description of the Surgical Technique

We studied the microselective neurotomy (MSN) and its advantages to alleviate disabling spasticity. The best indication for MSN is focal spasticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the lower limb) in 68 patients. The initial causes were: stroke, cranial trauma, postoperative complications and multiple sclerosis. MSN procedures were performed on the median nerve (n = 40) for wrist and finger flexion;musculo-cutaneus nerve (n = 38) for elbow flexion;ulnaris nerve (n = 9) for cubital deviation of the hand;gastrocnemius nerve (n = 98) and soleus nerve (n = 49) for equinus foot, tibial posterior nerve (n = 45) for varus foot, and fascicles (or bundles) of the flexor digitorum for “claw” toes (n = 19). The main preoperative test to identify the responsible nerve was a neuromuscular block with local anesthesia (lidocaine or bupivacaine) injected into the site of the nerve connecting the spastic muscle. During surgery, the identified nerve was exposed and its epineurium opened. Nerve bundles were teased apart into individual rootlets and a number of rootlets cut were previously planned, according to the spasticity. Follow-up was performed for up to 10 years, with a mean period of 29 months. Results demonstrated a reduction of limb spasticity of 2 to 3 points: modified Ashworth scale (MAS). Pain and clonus were also diminished in the affected limb. In some cases, voluntary movement was once again possible. MSN is a useful alternative in those cases of focal spasticity where physiotherapy and nerve block with botulinum toxin or phenol no longer produce satisfactory results.

Outcomes in spasticity after repetitive transcranial magnetic and transcranial direct current stimulations

Non-invasive brain stimulations mainly consist of repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Repetitive transcranial magnetic stimulation exhib- its satisfactory outcomes in improving multiple sclerosis, stroke, spinal cord injury and cerebral palsy-induced spasticity. By contrast, transcranial direct current stimulation has only been studied in post-stroke spasticity. To better validate the efficacy of non-invasive brain stimulations in im- proving the spasticity post-stroke, more prospective cohort studies involving large sample sizes are needed.

Botulinum toxin injection improved voluntary motor control in selected patients with post-stroke spasticity

The effect of botulinum toxin type A injection on voluntary grip control was examined in a 53-year-old female, who sustained a hemorrhagic right middle cerebral artery stroke 3 years previously, which resulted in finger flexor spasticity and residual weak finger/wrist extension. The patient received 50 units of botulinum toxin type A injection each to the motor points （2 sites/muscle） of the left flexor digitorum superficialis and flexor digitorum profundus, respectively. Botulinum toxin injection led to weakness and tone reduction in the spastic finger flexors, but improved grip release time in grip initiation/release reaction time tasks. Improved release time was accompanied by shortened extensor electromyography activity, and improved release time likely correlated with blocked co-contraction of finger flexors during voluntary finger extension. This case report demonstrated that botulinum toxin injection improved voluntary motor control of the hand in a chronic stroke patient with residual finger extension.

Dry needling at myofascial trigger points mitigates chronic post-stroke shoulder spasticity

Post-stroke spasticity is associated with restriction in the range of motion of the shoulder.Reducing muscular dystrophy may help relieve muscular dysfunction in patients with post-stroke shoulder spasticity.Dry needle therapy is a method of needling the trigger points using a syringe needle without the use of a drug.Dry needle therapy is commonly used for pain at the shoulder,neck,waist,and back.In this case study,a 62-year-old male patient affected with cerebral hemorrhage of the right frontal lobe had received rehabilitative treatment for 12 years.However,he still experienced shoulder spasticity.The patient received daily dry needling at the trigger points of infraspinatus,teres minor,posterior deltoid,and pectoralis major on 9 days.After the first and ninth treatment,the Modified Ashworth Scale and the passive range of motion of the shoulder was used to assess the effect of the treatment.The spasticity and range of motion of the shoulder showed obvious improvement.These results indicate that dry needling at the myofascial trigger points can effectively treat chronic poststroke shoulder spasticity.

Effects of High Frequency Repetitive Transcranial Magnetic Stimulation on KCC2 Expression in Rats with Spasticity Following Spinal Cord Injury

The effect of high-frequency repetitive transcranial magnetic stimulation（r TMS） on potassium-chloride cotransporter-2（KCC2） protein expression following spinal cord injury（SCI） and the action mechanism were investigated. SCI models were established in SD rats. Five groups were set up randomly： normal control group, SCI 7-day（7 D） model group, SCI 14-day（14 D） model group, SCI-7 DrTMS group and SCI-14 DrTMS group（n=5 each）. The rats in SCI rTMS groups were treated with 10 Hz rTMS from 8 th day and 15 th day after SCI respectively, once every day, 5 days every week, a total of 4 weeks. After the model establishment, motor recovery and spasticity alleviation were evaluated with BBB scale once a week till the end of treatment. Finally, different parts of tissues were dissected out for detection of variations of KCC2 protein using Western blotting and polymerase chain reaction（PCR） technique. The results showed that the BBS scores after treatment were significantly higher in SCI-7 DrTMS group than in SCI-14 DrTMS group（P〈0.05）. As compared with normal control groups, The KCC2 protein in SCI model groups was down-regulated after SCI, and the decrease was much more significant in SCI-14 D model group than in SCI-7 D group（P〈0.05）. As compared with SCI model groups, KCC2 protein in rTMS groups was up-regulated after the treatment（P〈0.05）. The up-regulation of KCC2 protein content and expression was more obvious in SCI-7 DrTMS group than in SCI-14 DrTMS group（P〈0.05）. It was concluded that 10 Hz rTMS can alleviate spasticity in rats with SCI, which might be attributed to the up-regulation of KCC2 protein. It was also suggested that the high-frequency rTMS treatment after SCI at early stage might achieve more satisfactory curative effectiveness.

Selective dorsal rhizotomy in cerebral palsy spasticity-a newly established operative technique in Slovenia: A case report and review of literature

BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when Fasano has published the first series of selective dorsal rhizotomy(SDR),neurosurgeons were able to provide such children only a modest help.The therapy of spasticity has made a great progress since then.Today,peroral drugs,intramuscular and intrathecal medicines are available,that may limit the effects of the disease.In addition,surgical treatment is gaining importance,appearing in the form of deep brain stimulation,peripheral nerve procedures and SDR.All these options offer the affected children good opportunities of improving the quality of life.CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy.Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles.Then,the SDR was made.CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.

Different frequencies of repetitive transcranial magnetic stimulation combined with local injection of botulinum toxin type A for post-stroke lower limb spasticity:study protocol for a prospective,single-center,non-randomized,controlled clinical trial

No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest research indicates that when combined with local injections of botulinum toxin type A,it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone.We designed a prospective,single-center,non-randomized,controlled clinical trial to investigate the safety and effica cy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen.This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hos pital of China Medical Unive rsity.All enrolled patients will undergo ro utine rehabilitation training and will be divided into five groups in-30 per group) according to the particular area of cerebral infa rction and treatment methods.G roup A:Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency(1 Hz)repetitive transcranial magnetic stimulation on the contralate ral side;G roup B:Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency(10-20 Hz) re petitive transcranial magnetic stimulation on the affected side;G roup C:Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A;G roup D:Patients with massive cerebral infarction will be given low-frequency(1 Hz) repetitive transcranial magnetic stimulation on the contralate ral side;and G roup E:Patients with non-massive cerebral infa rction will be given high-frequency(10-20 Hz) repetitive transcranial magnetic stimulation on the affected side.The primary outcome measure of this trial is a modified Ashwo rth scale score from 1 day before treatment to 12 months after treatment.Secondary outcome measures include Fugl-M eyer Assessment of Lower Extremity,Visual Analogue Scale,modified Barthel index,and Berg Balance Scale scores for the same time as specified for primary outcome measures.The safety indicator is the incidence of adverse events at 3-12 months after treatment.We hope to draw a definite conclusion on whether there are diffe rences in the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation,thereby screening out the optimal therapeutic regimen.The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University(approval No.[2021] 2021-333-3) on August 19,2021.The trial was registe red with the Chinese Clinical Trial Registry(Registration No.ChiCTR2100052180) on October 21,2021.The protocol version is 1.1.

Comparison of Baclofen and Tizanidine in Reducing Spasticity in Cerebral Palsy: A Randomized Control Trial

Background: Cerebral palsy is the most common chronic motor disability that begins in childhood with the predominant motor abnormality that is spasticity. Objective: The purpose of the present study was to compare the efficacy of oral baclofen and oral tizanidine in reducing spasticity in cerebral palsy patients. Methodology: This randomized controlled trial was conducted from January 2010 to December 2011 and it was carried out in the Out Patient Department (OPD) of Pediatrics at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh and Center for Neurodevelopment and Autism in Children (CNAC) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Results: A total number of 70 cerebral palsy children were recruited for this study of which 35 patients were in Tizanidine group and 35 patients were in baclofen group. Furthermore, 70 cerebral palsy children were taken as control who were treated with placebo. Tizanidine had superior efficacy in reducing tone in spastic cerebral palsy over baclofen measured by using Modified Ashworth scale in different time periods from AS score-3 to score-2 (p < 0.05). Tizanidine was also superior in joint angle improvement in spastic cerebral palsy measured by physician rating scale from AS score-3 to score-2 (crouch p < 0.0001) and foot contact from AS score-3 to score-2 (p < 0.0001);but no statistically significant improvement in gross motor function. Adverse effect was more in baclofen group. Conclusion: For reducing generalized spasticity with regards to muscle tone, joint angle and improvement in gait in cerebral palsy patients, tizanidine has superior efficacy and less adverse effects than baclofen.

Botulinum toxin injection for Cockayne syndrome with muscle spasticity over bilateral lower limbs:A case report

BACKGROUND Cockayne syndrome(CS)is a rare inherited disease characterized by progressive motor symptoms including muscle weakness,joint contracture,ataxia,and spasticity.Botulinum neurotoxin type A has been used for conditions such as dystonia and spasticity,but it has rarely been used in patients with CS.CASE SUMMARY We report a 6-year-and-9-mo old girl diagnosed with CS who received an injection of botulinum neurotoxin type A to manage her difficulty with walking.A total dose of 210 units of botulinum neurotoxin type A was administered into the bilateral tibialis posterior and gastrocnemius muscles.To evaluate the treatment effects on spasticity,joint contracture,pain,and ataxia,measurement tools including the Modified Ashworth Scale,the passive range of motion,the Faces Pain Scale-Revised,and the Scale for the Assessment and Rating of Ataxia,were employed.The first week after the injection,the Modified Ashworth Scale score for the plantar flexors and foot invertors improved bilaterally,along with advancements in the passive range of motion of the bilateral ankles and a lower score for the Faces Pain Scale-Revised.These treatment effects persisted to the 8th week post-injection,but returned to baseline values at the 12th week post-injection,except for the pain scale.CONCLUSION Botulinum toxin injection can thus be considered as a treatment option for lower extremity spasticity,joint contracture,and pain derived from CS.

Inter- and Intra-Rater Reliability of the Australian Spasticity Assessment Scale in Adults with Acquired Brain Injury

Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been shown to be superior to other clinical tools for the assessment of spasticity in children with cerebral palsy but reliability has not been previously examined in adults. Method: Four muscle groups were rated on one occasion by four assessors using the ASAS in sixteen adults with unilateral hypertonia following acquired brain injury. Twelve participants returned one week later for reassessment by the same assessors. Results: Overall inter-rater reliability of the ASAS using a quadratic weighted Kappa was moderate (Kqw 0.58) with ranges from moderate to good (Kqw 0.42 - 0.70). Agreement between raters was greatest for soleus muscle and least for wrist flexors. Overall intra-rater reliability of each of the four raters was moderate to good (Kqw 0.48 - 0.79). Agreement within raters was greatest for soleus muscle and least for biceps muscle. Conclusions: The ASAS may represent an appropriate alternative to the clinical scales currently used to assess spasticity;however inter and intra-rater reliability data from this investigation are lower than those which have previously been reported by experienced users of the ASAS in children with cerebral palsy. Further investigation with a larger sample size is warranted before any firm conclusions may be drawn about the reliability and validity of this tool to assess spasticity in adults with acquired brain injury.

Effect of Calcium Consumption on the Spasticity in the Spastic Rats

Spasticity is a stiff muscle condition because the muscles receive impulses continuously. Calcium ions play a role in the ability of nerves to stimulate muscle contraction. This study aimed to analyze the effect of calcium consumption on the changes of spasticity and the relation of calcium levels in the blood and muscle to the spasticity. The experimental study was conducted on 42 male Sprague-Dawley rats aged 12 - 14 weeks. The 15-d intervention was conducted on six groups of spastic rats by administering 20 g of feed containing 50 mg, 100 mg, and 200 mg of calcium, it also received 100 mg, 200 mg, and 300 mg of calcium lactate supplementation. The experimental rats were induced with 80 mg/kg BW of Erythrocin B through the tail vein to make them spastic. This study showed a tendency of increased spasticity along with the increased dose of calcium given to the subjects. There were significant differences (p = 0.007) in changes in spasticity between groups. The significant differences (p = 0.02) in changes in blood calcium levels. The Spearman’s correlations test on the changes in blood calcium levels and changes in spasticity showed a positive coefficient correlation (r = 0.097) with a p-value of 0.54. An increase in blood calcium levels and a large decrease in spasticity were found in the group receiving 100 mg calcium intake in 20 g of feed. The calcium levels in muscles had a significant correlation with spasticity (p = 0.038, r = 0.810). The calcium levels in the muscle had a strong correlation with blood calcium levels (p = 0.041, r = 0.748). The biggest decrease in spasticity occurred after 100 mg of calcium were given to the rats for 15 days, and it was considered as an optimal dose. The calcium levels in the muscles had a strong correlation with blood calcium levels and the spasticity of the spastic rats.

Overview of botulinum toxin as a treatment for spasticity in stroke patients

Spasticity after the occurrence of stroke induces limb deformity, functional disability and/or pain in patients, which limits their activities of daily living and deteriorates their quality of life. Botulinum toxin(BTX) has recently been reported as an efficacious therapeutic agent for the treatment of spasticity. Systematic review and meta-analysis studies have demonstrated that BTX therapy after stroke reduces spasticity and increases physical activity capacity and performance levels. Moreover, BTX can be used as an adjuvant in physiotherapy. Several studies have confirmed that the combination of BTX therapy and physiotherapy improves motor recovery. However, to date, only a few such combination studies have been conducted and their findings are considered preliminary and controversial. Therefore, future studies are required to determine the appropriate combination of treatment methods that will aid motor recovery.

Guided Botulinum Toxin Injections for Limbs Spasticity:The Winning Duets

Botulinum toxin found its way into a lot of medical treatments improving the quality of life in many clinical situations.When treating spasticity,this toxin is injected in the affected muscle to decrease its tension and hyperactivity.The isolation of the affected muscles for injection is done either by anatomical palpation of the muscle which is also known as non-guided injection technique,or by using the ultrasound or the electromyography also known guided injection technique.In this study which is a prospective observational study that included patients over a 6 months period,28 patients aged between 2 and 78 years,with spasticity na?ve to botulinum toxin injections or had already been injected more than 3 months ago,were injected using guided injection technique.The optimal doses of botulinum toxin were administered based on the age,the severity of the condition,and affected muscle groups.In pediatric population these were also calculated according to the body weight.All patients were evaluated pre and 4 weeks post injection using the MAS Score(Modified Ashworth Scale).Statistical analysis showed a very significant response to treatment as compared to the pre-injection condition,for upper limbs,lower limbs,and all muscle groups with almost absent significant local or systemic side effects(with a p value less than 0.001).Conclusion:guided techniques for botulinum toxin injections showed a great efficacy in the treatment of spasticity along with no regional or systemic side effects and are relatively well tolerated by patients.This finding leads to a better management of spasticity and to a decrease in oral medication intake and secondarily a decrease in their possible side effects.

Botulinum toxin type A combined with robot-assisted training for upper limb spasticity and motor function after stroke:a case report

This study is to report the clinical experience of of Botulinum toxin type A in combination with robot-assisted training on upper limb spasticity and motor function in stroke patient through a case report.The patient underwent combined treatment with Botulinum toxin type A and robot-assisted training of the upper limb for 3 weeks.Evaluation was performed before and after combined treatment,and 3 months follow-up after discharge.The following outcomes were measured:spasticity by the modified Ashworth scale,pain by the numeric rating scale,motor function by the Fugl-Meyer assessment in upper limb,and activity of daily living by the modified barthel index.The combined Botulinum toxin type A and robot-assisted training treatment had an obvious improvement in upper limb spasticity,pain,motor function and activity of daily living.Botulinum toxin type A combined with robot-assisted training therapy is worthy of further application in patients with spastic stroke.

Warm-needle acupuncture for limb spasticity post-stroke:a systematic review

Background:Warm acupuncture,or warm-needle acupuncture,is a traditional external treatment widely used in China for thousands of years.However,the effects of different treatment times on limb spasticity post-stroke have not been evaluated.Methods:We searched PubMed,Embase,the Cochrane Library,the Web of Science,the China National Knowledge Infrastructure,the Chinese Scientific and Journal Database,the Wanfang database,and the Chinese Biomedical Literature Database from inception to May 21st,2020,to seek information regarding randomized controlled trials studying warm-needle acupuncture for limb spasticity post-stroke.Two authors selected 24 studies fitting the eligibility criteria and developed this systematic review and meta-analysis.Results:Warm-needle acupuncture is shown to be more effective than other treatments used in the control groups(odds ratio(OR)=3.61,95%confidence intervals(CI)(2.51,5.19),P<0.001).This treatment decreased limb spasticity as assessed with the Modified Ashworth Scale(mean differences(MD)=−0.78,95%CI(−1.00,−0.56),P<0.001)and the Clinic Spasticity Index(MD=1.06,95%CI(0.51,1.60),P=0.0002),improved sensorimotor impairments according to the Fugl-Meyer Assessment(MD=9.51,95%CI(6.99,12.03),P<0.001),and improved activities of daily living according to the Barthel Index(MD=9.70,95%CI(6.27,13.12),P<0.001).Subgroup analysis based on the length of the treatment using the Modified Ashworth Scale,Fugl-Meyer Assessment,and Barthel Index showed better outcomes for patients who received more than 20 days of treatments(P<0.001).Conclusion:Warm-needle acupuncture is an effective treatment for limb spasticity post-stroke.A treatment frequency of more than 20 days appears to have better effectiveness than that of less than 20 days.