Clinical Uses of a Robot (Hybrid-Assisted Limb or HAL™) in Patients with Post-stroke Spasticity after Botulinum Toxin Injections

Okuno, Taketoshi; Takeuchi, Toshiaki; Takeda, Eiji; Izumi, Yuisin; Kaji, Ryuji

doi:10.2152/jmi.68.297

Cited by 4 publications

(3 citation statements)

References 14 publications

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Section: Toxin and Robot-assisted Motor Trainingmentioning

confidence: 99%

“…The single-joint hybrid assistive limb exoskeleton (HAL-SJ) has shown efficacy in assisting the flexion/extension movement of the elbow joint [93][94][95][96]. The robot is based on the principle of paired associative stimulation (PAS), relating the desire to move and the actual movement evoked proprioceptive feedback, promoting brain plasticity [93][94][95]. Repetitive median nerve stimulation, combined with transcranial magnetic stimulation (TMS) over the contralateral motor cortex, induces plastic changes in excitability and long-term potentiation in the brain, which is applicable to learning and memory [2].…”

Section: Toxin and Robot-assisted Motor Trainingmentioning

confidence: 99%

“…Repetitive median nerve stimulation, combined with transcranial magnetic stimulation (TMS) over the contralateral motor cortex, induces plastic changes in excitability and long-term potentiation in the brain, which is applicable to learning and memory [2]. However, the HAL-SJ has shown an immediate improvement in the active ROM of the elbow joint, even after a period of about 1 year from the BoNT injection, but only in the proximal region of the upper limb [95]. Despite these limitations, the combination therapy of conventional rehabilitation with robot-assisted training has been shown to be superior to BoNT injections with conventional rehabilitation alone [97][98][99].…”

Section: Toxin and Robot-assisted Motor Trainingmentioning

confidence: 99%

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Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches

Raciti,

Ammendolia

et al. 2024

Brain Sciences

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Spasticity is a very common sign in the neurological field. It can be defined as “a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes” associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life”. The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients’ performance and outcomes. The combined strategies might rise the toxin’s effect, lowering its dosages of botulinum and reducing side effects and costs.

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Section: Toxin and Robot-assisted Motor Trainingmentioning

confidence: 99%

Section: Toxin and Robot-assisted Motor Trainingmentioning

confidence: 99%

Section: Toxin and Robot-assisted Motor Trainingmentioning

confidence: 99%

See 1 more Smart Citation

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches

Raciti,

Ammendolia

et al. 2024

Brain Sciences

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Improvement in a post-stroke pediatric patient with hemiplegia: Use of a hand-arm bimanual intensive therapy with hybrid assistive limb

Matsumoto,

Yoshii,

Ikutomo

et al. 2024

Brain and Development

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Poststroke Spasticity: Pathophysiology and Management An Accurate Evaluation of Spasticity

Piseru,

Ignat

et al. 2024

Balneo and PRM Research Journal

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Stroke is a major contributor to long-term impairment and disability, affecting up to one-third of survivors and almost half of patients showing neurological deficit at six months. Spasticity affects approximately 25% of individuals within two weeks of a stroke and increases to 44% in patients who have had a second stroke. Severe or incapacitating spasticity affects 15% of post-stroke individuals. Poststroke spasticity is also linked to additional signs and symptoms of the upper motor neuron syndrome, such as simultaneous contraction of agonist and antagonist muscles, weakness of the muscles, and a lack of coordination. Spasticity arises due to aberrant neuroplasticity that develops after a stroke and there is currently no specific intervention method designed to address and correct this abnormal plasticity that takes place during the acute phase. Just before implementing any measures to deal with spasticity, it is crucial to evaluate the influence on the quality of life and level of severity. Several grading scales are used to measure spasticity such as the MAS and modified Tardieu scale.There are various therapeutic approaches that may be categorized into three main classes: physical, pharmaceutical, and surgical. Each class has a distinct purpose and is used at the appropriate moment to reduce the level of spasticity and improve the patient's health. Physiotherapy serves as a base of improving the patient's condition and facilitating the development of brain networks. The objective of post stroke spasticity management must include not only the reduction of muscle hypertonia, but also the evaluation of how post stroke influences functionality and overall mental health. Improper treatment or non-compliance may result in increased pain, joint contraction, and further disability. The goal is to assist the patient in achieving the best possible quality of life. Keywords: Pathophysiology of Post-Stroke Spasticity; Management of Post-Stroke Spasticity; Evaluation of Post-Stroke Spasticity

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Clinical Uses of a Robot (Hybrid-Assisted Limb or HAL™) in Patients with Post-stroke Spasticity after Botulinum Toxin Injections

Cited by 4 publications

References 14 publications

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches

Improvement in a post-stroke pediatric patient with hemiplegia: Use of a hand-arm bimanual intensive therapy with hybrid assistive limb

Poststroke Spasticity: Pathophysiology and Management An Accurate Evaluation of Spasticity

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