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Nasb M, Shah SZA, Chen H, Youssef AS, Li Z, Dayoub L, Noufal A, Allam AES, Hassanien M, El Oumri AA, Chang KV, Wu WT, Rekatsina M, Galluccio F, AlKhrabsheh A, Salti A, Varrassi G. Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e17645. [PMID: 34646693 PMCID: PMC8486367 DOI: 10.7759/cureus.17645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Stroke is considered one of the main causes of adult disability and the second most serious cause of death worldwide. The combination of botulinum toxin type A (BTX) with rehabilitation techniques such as modified constraint-induced movement therapy (mCIMT) has emerged as a highly efficient intervention for stroke patients to start synchronized motor function along with spasticity reduction. The current systematic review and meta-analysis were conducted in order to evaluate the available literature about the safety and efficacy of constraint-induced movement therapy (CIMT) combined with BTX in stroke patients with upper limb spasticity. Searches were conducted on WoS (Web of Science), Ovid, EBSCO-ASC&BSC, and PubMed for identifying relevant literature published from 2000-2020. Randomized Controlled Trials (RCTs) and Quasi-experimental studies were considered for inclusion. Rayyan (systematic review tool) QCRI (Qatar Computing Research Institute) was used for independent screening of the studies by two reviewers. For risk of bias and study quality assessment, Cochrane risk of bias tool (RoB 2) and Physiotherapy Evidence Database (PEDro) scales were used. Cochrane review manager was used to carry out the meta-analyses of the included studies. The search resulted in a total of 13065 references, of which 4967 were duplicates. After the title, abstract and full-text screening, two RCTs were deemed eligible for inclusion. Both the RCTs scored 8 on PEDro and were level evidence. The studies were heterogeneous. The findings of this meta-analysis in all the three joints post-stroke spasticity assessed on modified Ashworth scale (MAS) at four weeks post-injection aren't statistically significant (elbow P-value 0.74, wrist P-value 0.57, fingers P-value 0.42), however, according to one of the included studies the therapeutic efficacy of the combination of BTX-mCIMT injection assessed at four weeks post-injection in wrist and finger flexors was promising. The effectiveness of BTX-CIMT combination over conventional therapy (CT) for improving post-stroke spasticity still needs to be explored with long-term, multicenter rigorously designed RCTs having a good sample size. However, the BTX-CIMT combination is promising for enhancing motor function recovery and improving activities of daily living (ADLs).
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Affiliation(s)
- Mohammad Nasb
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, CHN
| | - Sayed Zulfiqar Ali Shah
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, CHN
| | - Hong Chen
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, CHN
| | - Ahmed S Youssef
- Department of Rehabilitation Medicine and Physical Therapy, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, CHN
| | - Zhenlan Li
- Department of Rehabilitation Medicine and Physical Therapy, First Hospital of Jilin University, Jilin University, Changchun, CHN
| | - Lamis Dayoub
- Department of Physical Therapy, Albaath University, Homs, SYR
| | - Abdullah Noufal
- Department of Orthopedic Surgery, Al-Assad University Hospital, Damascus University, Damascus, SYR
| | - Abdallah El Sayed Allam
- Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals & Faculty of Medicine, Tanta University, Tanta, EGY
| | - Manal Hassanien
- Department of Rheumatology, Assiut University Hospital, Assiut, EGY
| | - Ahmed Amine El Oumri
- Immunohematology Cellular Therapy, Medical School Oujda / Mohammed VI University Hospital of Oujda, Oujda, MAR
| | - Ke-Vin Chang
- Physical Medicine and Rehabilitation, National Taiwan University Hospital Bei-Hu Branch, Taipei, TWN
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, TWN
| | - Martina Rekatsina
- Pain Management, Whipps Cross Hospital Barts Health National Health Service (NHS), London, GBR
| | - Felice Galluccio
- Medical-Geriatric Department, Rheumatology, University Hospital Azienda Ospedaliero Universitaria (AOU) Careggi, Florence, ITA
| | - Abdullah AlKhrabsheh
- King Abdullah University Hospital, Jordan University of Science and Technology, Amman, JOR
| | - Ammar Salti
- Anesthesia and Pain Medicine, Cleveland Clinic, Abu Dhabi, ARE
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Jin Y, Jin X, Li J. Fu's subcutaneous needling and constraint-induced movement therapy for a patient with chronic stroke: One-year follow-up case report. Medicine (Baltimore) 2019; 98:e13918. [PMID: 30813122 PMCID: PMC6408031 DOI: 10.1097/md.0000000000013918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Spasticity is a common issue in chronic stroke. To date, no study has reported the long-term (up to 1 year) outcomes of Fu's subcutaneous needling in combination with constraint-induced movement therapy in chronic stroke. This report describes the successful addition of acupuncture on spasticity and arm function in a patient with chronic stroke and arm paresis. PATIENT CONCERNS The patient suffered an infarction in the right posterior limb of the internal capsule 1 year ago, which resulted in hemiparesis in his left (nondominant) hand and arm. The only limitation for constraint-induced movement therapy was insufficient finger extension. The patient was unable to voluntarily extend his interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy. However, his muscle tension did not change after the BTX type A injection. DIAGNOSES A 35-year-old male experienced arm paresis after an infarction in the right posterior limb of the internal capsule 1 year before the intervention. INTERVENTIONS The BTX type A injection did not work, so the patient received Fu's subcutaneous needling as an alternative therapy before 5 h of constraint-induced movement therapy for 12 weekdays. OUTCOMES All outcome measures (Modified Ashworth Scale, Fugl-Meyer Assessment, Action Research Arm Test, and Motor Activity Log) substantially improved over the 1-year period. Moreover, during the observation period, the patient's muscle tone and arm function did not worsen. LESSONS As a result of a reduction in spasticity, a reduction of learned nonuse behaviors, or use-dependent plasticity after the combined therapy, the arm functions include volitional movements, and coordination or speed of movements in the paretic arm have been improved. However, we cannot rule out the possibility of an influence of the passage of time or the Hawthorne effect. The costs of the treatment of stroke may be reduced, if this combined therapy proved useful in future controlled studies.
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Affiliation(s)
- Yuanyuan Jin
- Department of Acupuncture and Moxibustion, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, China
| | - Xiaoqing Jin
- Department of Acupuncture and Moxibustion, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, China
| | - Jiangru Li
- Department of Rehabilitation Medicine, The Shanghai International Medical Center, No. 4358, Kangxin Road, Pudong New District, Shanghai, China
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Jin Y, Jin X, Chen Y, Zhu J. Acupuncture and constraint-induced movement therapy for a patient with chronic stroke: One-year follow-up case report. Medicine (Baltimore) 2017; 96:e8737. [PMID: 29145321 PMCID: PMC5704866 DOI: 10.1097/md.0000000000008737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Spasticity is a widespread problem in chronic stroke. To date, no study has reported the long-term (up to 1 year) outcomes of acupuncture in combination with constraint-induced movement therapy in patients with chronic stroke. This report describes the successful addition of acupuncture on spasticity and arm function in a patient with chronic stroke and arm paresis. PATIENT CONCERNS At screening, the patient was unable to voluntarily extend her interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy. However, the BTX type A injection couldn't be used as she had ever suffered a severe allergic reaction in the injection of BTX type A for facial anti-wrinkle. DIAGNOSES A 40-year-old female experienced arm paresis after an infarction in the right posterior limb of the internal capsule 2 years before the intervention. INTERVENTIONS The BTX type A injection couldn't be used as she had ever suffered a severe allergic reaction in the injection of BTX type A for facial anti-wrinkle, so the patient received 1 hour of acupuncture as an alternative therapy before 5 hours of constraint-induced movement therapy for 12 weekdays. OUTCOMES All outcome measures (Modified Ashworth Scale, Fugl-Meyer Assessment, Action Research Arm Test, Motor Activity Log) substantially improved over the 1-year period. Moreover, during the observation period, the patient's muscle tone and arm function did not worsen. LESSONS As a result of a reduction in spasticity, a reduction of learned nonuse behaviors, or use-dependent plasticity after the combined therapy, the arm functions include volitional movements and coordination or speed of movements in the paretic arm have been improved. However, we can not rule out the possibility of an influence of the passage of time or the Hawthorne effect. The costs of the treatment of stroke may be reduced, if this combined therapy proved useful in future controlled studies.
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Melnikova EA. [Analysis of the cerebral mechanisms underlying rehabilitation of the patients after stroke]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2016; 92:4-10. [PMID: 26841522 DOI: 10.17116/kurort201564-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors present the results of the comprehensive analysis of the principal cerebral mechanisms involved in the processes of rehabilitation of the patients after stroke based on the review of the literature concerning this issue. The data obtained in the course of original investigations including 203 patients who had undergone stroke confirm and refine the currently available information pertinent to the problem in question. First and foremost, they demonstrate the influence of the demographic, neurophysiological, and clinical factors as well as neuroimaging and ultrasound studies on the parameters of the evoked potentials in the brain of the stroke-affected patients. In addition, they provide a deeper insight into the role of short-term memory in the realization of the motor response. The probable macro- and microstructural, functional, neurochemical, and pathophysiological mechanisms contributing to the rehabilitation of the patients who had undergone stroke are considered with reference to their relationships. Special emphasis is laid on the methods for regulation of these mechanisms.
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Affiliation(s)
- E A Melnikova
- State autonomous healthcare facility 'Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine', Moscow Health Department, Moscow, Russian Federation, 105120
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Razumov AN, Melnikova EA. [The modern approaches to the prognostication of rehabilitation of the patients after stroke on an individual basis: a review of the literature and the results of original investigations]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2015; 92:11-16. [PMID: 26841523 DOI: 10.17116/kurort2015611-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article was designed to analyze the results of the investigations with the purpose of elucidation of the prognostic factors relevant to the rehabilitation of the patients who survived after stroke. Special attention is given to the role of demographic (age and sex) factors and the data of the clinical, neurological, psychological, cognitive, and instrumental examination of the patients. The results of the original studies based on the treatment of 203 stroke patients are discussed in the context of modern concepts of the significance of the factors contributing to the recovery of the patients in the course of the post-stroke rehabilitation. The prognostic value of the selected factors, such as leukoareosis (for the patients presenting with hemorrhagic stroke), has been demonstrated for the first time. The new data on the duration of the rehabilitation period are presented with reference to its dependence on the type of stroke and localization of the lesions. Specifically, it is estimated to be 2 years for the patients who suffered from ischemic stroke in the brain stem, 31 months for those with ischemic stroke of the hemispherical localization, and 38 months for the patients presenting with hemorrhagic stroke (hemispherical hematoma). In addition, the data on the magnitude of the post-ischemic atrophic changes of prognostic values are presented.
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Affiliation(s)
- A N Razumov
- State autonomous healthcare facility 'Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine', Moscow Health Department, Moscow, Russian Federation, 105120
| | - E A Melnikova
- State autonomous healthcare facility 'Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine', Moscow Health Department, Moscow, Russian Federation, 105120
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