Upper limb motor improvement in chronic stroke after combining botulinum toxin A injection and multi-joints robot-assisted therapy: a case report

Abstract

Spasticity is one of the major complications after stroke. Botulinum toxin type A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve activities of daily living function of paretic arm. The recovery of functions of the affected arm is also the aim of robotic upper limb (UL) therapy. The motorized exoskeleton assists the patient in a large 3D work environment by promoting movement for the UL (shoulder, elbow, wrist, hand). The combination of the BoNT-A injection and the robotic therapy might enhance functional recovery after stroke. We reported the case of a chronic stroke patient in which the injection of BoNT-A was combined with multi-joint exoskeleton training. The patient showed improvement in the motor control of the UL, supporting the feasibility of this approach.

<p>Botulinum Toxin Type A Possibly Affects Ca_v3.2 Calcium Channel Subunit in Rats with Spinal Cord Injury-Induced Muscle Spasticity</p>

“…Food and Drug Administration (FDA) has approved BoT-A for the treatment of strabismus, eyelid spasm, neck dystonia, and cosmetic disorders. A large number of clinical randomized controlled trials and retrospective analyses have demonstrated that BoT-A injection reduces muscle tone, 39 expands joint mobility of affected joints, 40,41 and indirectly improves motor function of patients, 42 which makes BoT-A suitable in the prevention of muscle spasticity. 43 Toxin is a neurotoxin produced by Clostridium botulinum in anaerobic environment.…”

Clinical Interpretation of Working Volume and Weight Support in Upper Limb Robotic Neurorehabilitation after Stroke

“…A support > 100% could also compensate for adjunctive forces directed downwards. The device also includes an interface used for the exergame, designed to obtain task-oriented gestures in a specifically developed video game environment with exergames specifically developed for rehabilitative purposes [20,21]. The computer-robot interface is designed to provide some exergames requiring specific upper limb movements consisting of single-joint movements around a single axis or combined movements of single joint around two or three axes, exercises for the opening and closing hand (grasping exercises) and multi-joint exercises along one, two or three spatial axes (coordination exercises).…”

“…The computer-robot interface is designed to provide some exergames requiring specific upper limb movements consisting of single-joint movements around a single axis or combined movements of single joint around two or three axes, exercises for the opening and closing hand (grasping exercises) and multi-joint exercises along one, two or three spatial axes (coordination exercises). The training characteristics (difficulty level, duration, visual detail) were set conforming to the residual ability of the patient [21].…”

“…At T1 and T2, the data related to joint ROMs and the total working volume obtained with passive mobilization of the paretic upper limb performed by a therapist up to the articular limit in the three planes of the space were collected, together with the weight support selected for performing the proposed exergames and analyzed with Armeo ® Control Software (Figure 1). According to previous studies [11][12][13]21,22], the assessment procedure was performed with the measure of the patient's passive range of motion with the robotic device in a kinematic transparent mode, and the therapist moving the affected limb linked to the exoskeleton for exploring the entire reachable space to interact with the video game during therapy without experiencing resistance to the movement or elicit pain.…”

Efficacy of Robotic Rehabilitation on Hand Function and Activity of Daily Living in Stroke Patients

“…14 El fonksiyonları üzerine yapılan az sayıdaki çalışmada üst ekstremite robotik rehabilitasyonunun olumlu etkileri bildirilmiştir. [15][16][17] Ülkemizde bu alanda yapılmış klinik çalışmaya rastlanmamıştır. Bu çalışmada kronik inmeli hastalarda üst ekstremite robotik rehabilitasyonun el fonksiyonları ve GYA'ya katkısının incelenmesi amaçlanmıştır.…”