Case Study of a Chronic Stroke Patient with Lower Limb Spasticity Who Showed Improvement in Walking Endurance after a Physical Therapy Intervention with Botulinum Therapy and Functional Electrical Stimulation
[Purpose] Although spasticity of the lower limbs in chronic stroke patients causes gait disturbance, there are few reports of useful interventions to improve their walking ability. The purpose of this paper is to report the course of an intervention for a chronic stroke patient who showed improvemen...
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| Published in | Rigaku ryoho kagaku Vol. 36; no. 4; pp. 647 - 652 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Tokyo
The Society of Physical Therapy Science
2021
Japan Science and Technology Agency |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1341-1667 2434-2807 |
| DOI | 10.1589/rika.36.647 |
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| Abstract | [Purpose] Although spasticity of the lower limbs in chronic stroke patients causes gait disturbance, there are few reports of useful interventions to improve their walking ability. The purpose of this paper is to report the course of an intervention for a chronic stroke patient who showed improvement in walking endurance after a physical therapy intervention with botulinum therapy and functional electrical stimulation (FES). [Participant and Methods] The case was a 39-year-old female who had right paraplegia and spasticity of the lower limbs due to left parietal lobe subcortical hemorrhage 9 years earlier. During the course of 24 months, botulinum therapy was administered 4 times for lower limb spasticity, and in addition to the usual interventions, gait practice with FES was performed in outpatient physical therapy. The 6-minute walk test (6MWT) was evaluated as an index of walking endurance. [Results] The mean intervention time was 10.3 hours/month. The 6MWT distances before and after the intervention were 162 m and 275 m, respectively. [Conclusion] The results suggest that physical therapy combined with botulinum therapy and FES may contribute to the improvement of walking ability of chronic stroke patients with lower limb spasticity. |
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| AbstractList | [Purpose] Although spasticity of the lower limbs in chronic stroke patients causes gait disturbance, there are few reports of useful interventions to improve their walking ability. The purpose of this paper is to report the course of an intervention for a chronic stroke patient who showed improvement in walking endurance after a physical therapy intervention with botulinum therapy and functional electrical stimulation (FES). [Participant and Methods] The case was a 39-year-old female who had right paraplegia and spasticity of the lower limbs due to left parietal lobe subcortical hemorrhage 9 years earlier. During the course of 24 months, botulinum therapy was administered 4 times for lower limb spasticity, and in addition to the usual interventions, gait practice with FES was performed in outpatient physical therapy. The 6-minute walk test (6MWT) was evaluated as an index of walking endurance. [Results] The mean intervention time was 10.3 hours/month. The 6MWT distances before and after the intervention were 162 m and 275 m, respectively. [Conclusion] The results suggest that physical therapy combined with botulinum therapy and FES may contribute to the improvement of walking ability of chronic stroke patients with lower limb spasticity. |
| Author | HAYASHI, Shota IGARASHI, Tatsuya |
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| References | 4) Sun LC, Chen R, Fu C, et al.: Efficacy and safety of botulinum toxin type A for limb spasticity after stroke: a meta-analysis of randomized controlled trials. BioMed Res Int, 2019, 2019: 8329306. 22) 村岡慶裕，正門由久，富田 豊・他：治療的電気刺激による脳卒中患者の足関節筋群における2シナプス性Ia相反抑制の変化．リハビリテーション医学，2000, 37: 453-458. 7) Kluding PM, Dunning K, O’Dell MW, et al.: Foot drop stimulation versus ankle foot orthosis after stroke: 30-week outcomes. Stroke, 2013, 44: 1660-1669. 8) Bethoux F, Rogers HL, Nolan KJ, et al.: Long-term follow-up to a randomized controlled trial comparing peroneal nerve functional electrical stimulation to an ankle foot orthosis for patients with chronic stroke. Neurorehabil Neural Repair, 2015, 29: 911-922. 3) Watkins CL, Leathley MJ, Gregson JM, et al.: Prevalence of spasticity post stroke. Clin Rehabil, 2002, 16: 515-522. 16) Fulk GD, He Y: Minimal clinically important difference of the 6-minute walk test in people with stroke. J Neurol Phys Ther, 2018, 42: 235-240. 30) CARE Case Report Guidelines. https://www.care-statement.org/index.html（閲覧日2020年12月3日） 21) 木村彰男，安保雅博，川手信行他・他：A型ボツリヌス毒素製剤（Botulinum Toxin Type A）の脳卒中後の下肢痙縮に対する臨床評価─プラセボ対照二重盲検群間比較試験ならびにオープンラベル反復投与試験─．Jpn J Rehabil Med, 2010, 47: 626-636. 23) Fulk GD, He Y, Boyne P, et al.: Predicting home and community walking activity poststroke. Stroke, 2017, 48: 406-411. 9) Stein C, Fritsch CG, Robinson C, et al.: Effects of electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials. Stroke, 2015, 46: 2197-2205. 1) Lance JW: Symposium synopsis. In: Feldman RG, Young RR, Koella WP (eds): Spasticity: Disorderd Motor Control. Symposia Specialists, Miami, 1980, pp485-494. 6) Gupta AD, Chu WH, Howell S, et al.: A systematic review: efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity. Syst Rev, 2018, 7: 1. 11) Johnson CA, Burridge JH, Strike PW, et al.: The effect of combined use of botulinum toxin type A and functional electric stimulation in the treatment of spastic drop foot after stroke: a preliminary investigation. Arch Phys Med Rehabil, 2004, 85: 902-909. 29) Frasson E, Priori A, Ruzzante B, et al.: Nerve stimulation boosts botulinum toxin action in spasticity. Mov Disord, 2005, 20: 624-629. 2) Sommerfeld DK, Eek EU, Svensson AK, et al.: Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke, 2004, 35: 134-139. 19) Dietz V, Sinkjaer T: Secondary changes after damage of the central nervous system significance of spastic muscle tone in rehabilitation. In: Dietz V, Ward NS (eds): Oxford Textbook of Neurorehabilitation. Oxford University Press, Oxford, 2015. 24) Hachisuka K, Ochi M, Kikuchi T, et al.: Clinical effectiveness of peroneal nerve functional electrical stimulation in chronic stroke patients with hemiplegia (PLEASURE): a multicentre, prospective, randomised controlled trial. Clin Rehabil, 2021, 35: 367-377. 12) Baricich A, Picelli A, Carda S, et al.: Electrical stimulation of antagonist muscles after botulinum toxin type A for post-stroke spastic equinus foot. A randomized single-blind pilot study. Ann Phys Rehabil Med, 2019, 62: 214-219. 18) Stein RB, Chong S, Everaert DG, et al.: A multicenter trial of a footdrop stimulator controlled by a tilt sensor. Neurorehabil Neural Repair, 2006, 20: 371-379. 17) TEIJIN Medical Web：ウォークエイド®．https://medical.teijin-pharma.co.jp/zaitaku/product/walkaide/（閲覧日2020年12月3日） 14) Fulk GD, Echternach JL, Nof L, et al.: Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke. Physiother Theory Pract, 2008, 24: 195-204. 25) Lewek MD, Sykes R 3rd: Minimal detectable change for gait speed depends on baseline speed in individuals with chronic stroke. J Neurol Phys Ther, 2019, 43: 122-127. 20) Nielsen JB, Christensen MS, Farmer SF, et al.: Spastic movement disorder: should we forget hyperexcitable stretch reflexes and start talking about inappropriate prediction of sensory consequences of movement? Exp Brain Res, 2020, 238: 1627-1636. 28) Ng SS, Hui-Chan CW: The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil, 2005, 86: 1641-1647. 10) Prenton S, Hollands KL, Kenney LP, et al.: Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: a meta-analysis providing direction for future research. J Rehabil Med, 2018, 50: 129-139. 5) Wu T, Li JH, Song HX, et al.: Effectiveness of botulinum toxin for lower limbs spasticity after stroke: a systematic review and meta-analysis. Top Stroke Rehabil, 2016, 23: 217-223. 26) Hiengkaew V, Jitaree K, Chaiyawat P: Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Arch Phys Med Rehabil, 2012, 93: 1201-1208. 27) Kim CM, Eng JJ: The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther, 2003, 83: 49-57. 13) Intiso D, Santamato A, Di Rienzo F: Effect of electrical stimulation as an adjunct to botulinum toxin type A in the treatment of adult spasticity: a systematic review. Disabil Rehabil, 2017, 39: 2123-2133. 15) Amsterdam Public Health: COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 2019. http://www.cosmin.nl（閲覧日2020年12月3日） |
| References_xml | – reference: 11) Johnson CA, Burridge JH, Strike PW, et al.: The effect of combined use of botulinum toxin type A and functional electric stimulation in the treatment of spastic drop foot after stroke: a preliminary investigation. Arch Phys Med Rehabil, 2004, 85: 902-909. – reference: 2) Sommerfeld DK, Eek EU, Svensson AK, et al.: Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke, 2004, 35: 134-139. – reference: 19) Dietz V, Sinkjaer T: Secondary changes after damage of the central nervous system significance of spastic muscle tone in rehabilitation. In: Dietz V, Ward NS (eds): Oxford Textbook of Neurorehabilitation. Oxford University Press, Oxford, 2015. – reference: 4) Sun LC, Chen R, Fu C, et al.: Efficacy and safety of botulinum toxin type A for limb spasticity after stroke: a meta-analysis of randomized controlled trials. BioMed Res Int, 2019, 2019: 8329306. – reference: 29) Frasson E, Priori A, Ruzzante B, et al.: Nerve stimulation boosts botulinum toxin action in spasticity. Mov Disord, 2005, 20: 624-629. – reference: 12) Baricich A, Picelli A, Carda S, et al.: Electrical stimulation of antagonist muscles after botulinum toxin type A for post-stroke spastic equinus foot. A randomized single-blind pilot study. Ann Phys Rehabil Med, 2019, 62: 214-219. – reference: 17) TEIJIN Medical Web：ウォークエイド®．https://medical.teijin-pharma.co.jp/zaitaku/product/walkaide/（閲覧日2020年12月3日）． – reference: 13) Intiso D, Santamato A, Di Rienzo F: Effect of electrical stimulation as an adjunct to botulinum toxin type A in the treatment of adult spasticity: a systematic review. Disabil Rehabil, 2017, 39: 2123-2133. – reference: 7) Kluding PM, Dunning K, O’Dell MW, et al.: Foot drop stimulation versus ankle foot orthosis after stroke: 30-week outcomes. Stroke, 2013, 44: 1660-1669. – reference: 28) Ng SS, Hui-Chan CW: The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil, 2005, 86: 1641-1647. – reference: 10) Prenton S, Hollands KL, Kenney LP, et al.: Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: a meta-analysis providing direction for future research. J Rehabil Med, 2018, 50: 129-139. – reference: 23) Fulk GD, He Y, Boyne P, et al.: Predicting home and community walking activity poststroke. Stroke, 2017, 48: 406-411. – reference: 5) Wu T, Li JH, Song HX, et al.: Effectiveness of botulinum toxin for lower limbs spasticity after stroke: a systematic review and meta-analysis. Top Stroke Rehabil, 2016, 23: 217-223. – reference: 16) Fulk GD, He Y: Minimal clinically important difference of the 6-minute walk test in people with stroke. J Neurol Phys Ther, 2018, 42: 235-240. – reference: 20) Nielsen JB, Christensen MS, Farmer SF, et al.: Spastic movement disorder: should we forget hyperexcitable stretch reflexes and start talking about inappropriate prediction of sensory consequences of movement? Exp Brain Res, 2020, 238: 1627-1636. – reference: 8) Bethoux F, Rogers HL, Nolan KJ, et al.: Long-term follow-up to a randomized controlled trial comparing peroneal nerve functional electrical stimulation to an ankle foot orthosis for patients with chronic stroke. Neurorehabil Neural Repair, 2015, 29: 911-922. – reference: 9) Stein C, Fritsch CG, Robinson C, et al.: Effects of electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials. Stroke, 2015, 46: 2197-2205. – reference: 21) 木村彰男，安保雅博，川手信行他・他：A型ボツリヌス毒素製剤（Botulinum Toxin Type A）の脳卒中後の下肢痙縮に対する臨床評価─プラセボ対照二重盲検群間比較試験ならびにオープンラベル反復投与試験─．Jpn J Rehabil Med, 2010, 47: 626-636. – reference: 25) Lewek MD, Sykes R 3rd: Minimal detectable change for gait speed depends on baseline speed in individuals with chronic stroke. J Neurol Phys Ther, 2019, 43: 122-127. – reference: 14) Fulk GD, Echternach JL, Nof L, et al.: Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke. Physiother Theory Pract, 2008, 24: 195-204. – reference: 26) Hiengkaew V, Jitaree K, Chaiyawat P: Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Arch Phys Med Rehabil, 2012, 93: 1201-1208. – reference: 27) Kim CM, Eng JJ: The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther, 2003, 83: 49-57. – reference: 15) Amsterdam Public Health: COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 2019. http://www.cosmin.nl（閲覧日2020年12月3日）． – reference: 30) CARE Case Report Guidelines. https://www.care-statement.org/index.html（閲覧日2020年12月3日）． – reference: 1) Lance JW: Symposium synopsis. In: Feldman RG, Young RR, Koella WP (eds): Spasticity: Disorderd Motor Control. Symposia Specialists, Miami, 1980, pp485-494. – reference: 6) Gupta AD, Chu WH, Howell S, et al.: A systematic review: efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity. Syst Rev, 2018, 7: 1. – reference: 22) 村岡慶裕，正門由久，富田 豊・他：治療的電気刺激による脳卒中患者の足関節筋群における2シナプス性Ia相反抑制の変化．リハビリテーション医学，2000, 37: 453-458. – reference: 18) Stein RB, Chong S, Everaert DG, et al.: A multicenter trial of a footdrop stimulator controlled by a tilt sensor. Neurorehabil Neural Repair, 2006, 20: 371-379. – reference: 3) Watkins CL, Leathley MJ, Gregson JM, et al.: Prevalence of spasticity post stroke. Clin Rehabil, 2002, 16: 515-522. – reference: 24) Hachisuka K, Ochi M, Kikuchi T, et al.: Clinical effectiveness of peroneal nerve functional electrical stimulation in chronic stroke patients with hemiplegia (PLEASURE): a multicentre, prospective, randomised controlled trial. Clin Rehabil, 2021, 35: 367-377. |
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| Title | Case Study of a Chronic Stroke Patient with Lower Limb Spasticity Who Showed Improvement in Walking Endurance after a Physical Therapy Intervention with Botulinum Therapy and Functional Electrical Stimulation |
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