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Takashi N, Musumari PM, Techasrivichien T, Suguimoto SP, Ono-Kihara M, Kihara M, Nakayama T. Unmet needs in long-term outpatient rehabilitative care: a qualitative and multi-perspective study in Japan. Disabil Rehabil 2023; 45:3668-3676. [PMID: 36254819 DOI: 10.1080/09638288.2022.2133177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/02/2022] [Accepted: 10/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study explores the experiences and unmet needs related to post-discharge long-term rehabilitation from triadic perspective of male patients with stroke, caregivers, and rehabilitation professionals. METHODS This is an exploratory qualitative study using in-depth interviews conducted in two outpatient rehabilitation facilities in Japan. Nine male patients with stroke, ten caregivers, and five rehabilitation professionals participated in this study. The data were coded, followed by thematic analysis. RESULTS Patients who did not achieve further physical recovery regardless of their efforts experienced a loss of motivation and lost sight of their goals. Moreover, caregivers regarded such patients as lazy and reported feeling frustrated with them. Furthermore, patients and caregivers had unmet needs regarding communication with professionals and psychological and emotional care. In contrast, professionals perceived time constraints on outpatient rehabilitation service provision and sometimes narrowed the scope of the care approach to physical function aspects for providing services efficiently. They also expressed difficulties in identifying patients' needs, values, and meaningful goals. CONCLUSIONS These findings suggest that in Japanese post-stroke outpatient rehabilitation, there is a need to adopt a comprehensive care approach, enhance the quality of communication, and involve caregivers in the rehabilitation process in limited-resource situations.IMPLICATIONS FOR REHABILITATIONIn long-term outpatient rehabilitation services in the community, stroke patients and their caregivers often face a physical recovery plateau.A comprehensive approach such as enhancing the quality of communication and providing psychological and emotional care -other than physical rehabilitation- is needed, particularly once the patient physical recovery stagnates.Involving caregivers in the rehabilitation process may be helpful for rehabilitation professionals to understand a potential problem that the patient cannot express but the caregiver can.It can be crucial to develop strategies that enable the rehabilitation professionals to provide a comprehensive care approach and prevent too much reliance on physical rehabilitation under the time-constraint situation in outpatient rehabilitation services.
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Affiliation(s)
- Naoki Takashi
- Graduate School of Medicine, School of Public Health, Department of Global Health and Socio-Epidemiology, Kyoto University, Kyoto, Japan
| | - Patou Masika Musumari
- Graduate School of Medicine, School of Public Health, Department of Global Health and Socio-Epidemiology, Kyoto University, Kyoto, Japan
| | - Teeranee Techasrivichien
- Graduate School of Medicine, School of Public Health, Department of Global Health and Socio-Epidemiology, Kyoto University, Kyoto, Japan
| | - S Pilar Suguimoto
- Graduate School of Medicine, School of Public Health, Department of Global Health and Socio-Epidemiology, Kyoto University, Kyoto, Japan
| | - Masako Ono-Kihara
- Graduate School of Medicine, School of Public Health, Department of Global Health and Socio-Epidemiology, Kyoto University, Kyoto, Japan
| | - Masahiro Kihara
- Graduate School of Medicine, School of Public Health, Department of Global Health and Socio-Epidemiology, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
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Wong MNK, Tong H, Cheung MKT, Ng YM, Yuan HL, Lam BYH, Fu SN, Chan CCH. Goal-setting and personalization under the International Classification of Functioning, Disability, and Health framework: Community reintegration program for post-stroke patients. Front Rehabil Sci 2023; 4:1219662. [PMID: 37600161 PMCID: PMC10436562 DOI: 10.3389/fresc.2023.1219662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
Background Body functions and structures, activities, and participation are the core components in the International Classification of Functioning, Disability, and Health (ICF) to identify post-stroke patients' health conditions. The specification of health conditions enhances the outcomes of post-stroke rehabilitation. Purpose This study aimed to explore the extent and the processes in an ICF-based post-stroke rehabilitation program (ICF-PSRP) that could enhance patients' community reintegration level. Methods Post-stroke patients who completed the ICF-PSRP participated in intake and pre-discharge individual face-to-face semi-structured interviews. In addition, case therapists were invited to a face-to-face semi-structured group interview. Clinician experts were invited to complete an interview with the same interview contents as case therapists but in an online format. All interview recordings were analyzed with the Framework analysis. Patients' treatment goals were mapped with the ICF Core Set for Stroke. Results Out of 37 invited post-stroke patients, thirty-three of them completed the interview. Three case therapists and five clinicians completed the interviews. The goals set by the patients and their caregivers showed a broadening of their scope over the course of the program. The changes in scope ranged from the activities to the participation and environmental components. Increases in patient-therapist interactions played an essential role in the goal-setting process, which were integral to personalizing the treatment content. These characteristics were perceived by all parties who contributed to the program outcomes. Conclusion The application of ICF's principles and core components offers a useful framework for enhancing post-stroke patients' community reintegration level. Future studies should explore the way in which patient-therapist interaction, exposure to environmental factors, and personalized interventions maximize the benefits of applying this framework to the community integration of post-stroke patients.
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Affiliation(s)
- Mabel Ngai-Kiu Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Horace Tong
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Mike Kwun-Ting Cheung
- Centre on Research and Advocacy, The Hong Kong Society of Rehabilitation, Hong Kong SAR, China
| | - Yuk-Mun Ng
- Rehabilitation Division, The Hong Kong Society for Rehabilitation, Hong Kong SAR, China
| | - Huan-Ling Yuan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Bess Yin-Hung Lam
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong SAR, China
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Chetwyn Che Hin Chan
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
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Kayola G, Mataa MM, Asukile M, Chishimba L, Chomba M, Mortel D, Nutakki A, Zimba S, Saylor D. Stroke Rehabilitation in Low- and Middle-Income Countries: Challenges and Opportunities. Am J Phys Med Rehabil 2023; 102:S24-S32. [PMID: 36634327 PMCID: PMC9846582 DOI: 10.1097/phm.0000000000002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Stroke remains the second leading cause of global disability with 87% of stroke-related disability occurring in low- and middle-income countries. In low- and middle-income countries, access to acute stroke interventions is often limited, making effective poststroke rehabilitation potentially the best available intervention to promote poststroke recovery. Here, we build on our experience as an illustrative example of barriers individuals with stroke face in accessing rehabilitation services and review the literature to summarize challenges to providing effective rehabilitation in low- and middle-income countries. First, we focus on barriers individuals with stroke face in accessing rehabilitation in low- and middle-income countries, including health system barriers, such as lack of national guidelines, low prioritization of rehabilitation services, and inadequate numbers of skilled rehabilitation specialists, as well as patient factors, including limited health literacy, financial constraints, and transportation limitations. Next, we highlight consequences of this lack of rehabilitation access, including higher mortality, poorer functional outcomes, financial burden, caregiver stress, and loss of gross domestic product at a national level. Finally, we review possible strategies that could improve access and quality of rehabilitation services in low- and middle-income countries, including creation of inpatient stroke units, increased training opportunities for rehabilitation specialists, task shifting to available healthcare workers or caregivers, telerehabilitation, and community-based rehabilitation services.
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Affiliation(s)
- Grace Kayola
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Melody Asukile
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Lorraine Chishimba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mashina Chomba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Dominique Mortel
- Department of Neurology, Johns Hopkins University School of Medicine
| | | | - Stanley Zimba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
- Department of Neurology, Johns Hopkins University School of Medicine
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Chau JPC, Lo SHS, Butt L, Liang S. Post-Stroke Experiences and Rehabilitation Needs of Community-Dwelling Chinese Stroke Survivors: A Qualitative Study. Int J Environ Res Public Health 2022; 19:16345. [PMID: 36498415 PMCID: PMC9741278 DOI: 10.3390/ijerph192316345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Stroke survivors encounter significant limitations in daily life activities and face increased risk of health complications such as stroke recurrence. Considering the escalating demand for personalised community rehabilitation services, this qualitative study was conducted to understand the current recovery experiences, needs, and expectations of community-dwelling stroke survivors. Fifty stroke survivors were recruited from two tertiary teaching hospitals and community centres in two provinces in mainland China. Semi-structured interviews were carried out, and participants were asked to describe their experiences of stroke, current lifestyles, exercise habits, and rehabilitation needs and expectations. Resulting data were thematically analysed. The majority of participants were first-time stroke survivors (80%) and lived with their family or caregivers (92%). Four main themes and twelve sub-themes emerged from the data: (1) shifts in social life, (2) shaken sense of self and perceived helplessness, (3) complex rehabilitation needs, and (4) perceptions and patterns of physical activity. Findings suggest that though survivors recognised their need for further rehabilitation, their demands remained unmet due to a combination of personal and external factors such as limited mobility and the absence of supportive companions and accessible facilities. The enhancement and diversification of home rehabilitation strategies are therefore necessary to make community rehabilitation more accessible and equitable.
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Roman NA, Miclaus RS, Nicolau C, Sechel G. Customized Manual Muscle Testing for Post-Stroke Upper Extremity Assessment. Brain Sci 2022; 12:brainsci12040457. [PMID: 35447988 PMCID: PMC9029412 DOI: 10.3390/brainsci12040457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
In neuro-rehabilitation, the assessment of post-stroke patients’ motor function of damaged upper extremities (UEs) is essential. Clinicians need clear and concise assessment instruments to monitor progress recorded in intensive rehabilitation sessions. One such instrument is Manual Muscle Testing (MMT), which, in our view, requires a modified scoring model aimed at improving the assessment process of patients’ motor and functional UE status, and recording their step-by-step-progress, especially if patients undergo a short length of hospitalization (of about 10 therapy days). Hence, this paper presents a new scoring system developed by the authors. This systemresults in a more precise MMT grading scale, which has more grades and can provide a more specific muscular assessment, while offering more clarity in quantifying patients’ progress after physical therapy. A prospective study was made of 41 post-stroke patients with upper extremity (UE) impairments. To determine the validity of the assessment tool for hypothesizing, and the unidimensionality and internal consistency of the customized model, exploratory and confirmatory factor analysis (CFA) with a structural equation model (SEM), Cronbach’s Alpha, and Pearson correlation coefficients were used with Fugl−Meyer (FM) assessments, the Modified Ashworth Scale (MAS), AROM, and the Modified Rankin Scale (MRS). Considering the unidimensionality of the instrument used, we performed a linear regression to identify whether certain movements performed segmentally by the manually evaluated muscles influence the measured manual score of the whole UE. All indices suggested a good model fit, and a Cronbach’s Alpha of 0.920 suggested strong internal consistency. The Pearson correlation coefficient of the MMT-customized score with AROM was 0.857, p < 0.001; that with FMUE was 0.905, p < 0.001; that with MRS was −0.608, p = 0.010; and that with MAS was −0.677, p < 0.001. The linear regression results suggest that wrist extensors, shoulder abductors, and finger flexors can influence the manual assessment of the muscle strength of the whole UE, thereby improving post-stroke patient management. The results of our research suggest that, using the proposed scoring, MMT may be a useful tool for UE assessment in post-stroke patients.
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Affiliation(s)
- Nadinne Alexandra Roman
- Faculty of Medicine, Transilvania University of Brasov, 500036 Brasov, Romania; (N.A.R.); (G.S.)
| | - Roxana Steliana Miclaus
- Faculty of Medicine, Transilvania University of Brasov, 500036 Brasov, Romania; (N.A.R.); (G.S.)
- Correspondence:
| | - Cristina Nicolau
- Faculty of Economic Sciences and Business Administration, Transilvania University of Brasov, 500036 Brasov, Romania;
| | - Gabriela Sechel
- Faculty of Medicine, Transilvania University of Brasov, 500036 Brasov, Romania; (N.A.R.); (G.S.)
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Cho Y, Hamm JM, Heckhausen J, Cramer SC. The role of goal adjustment during rehabilitation from stroke. Appl Psychol Health Well Being 2021; 14:26-43. [PMID: 34125996 DOI: 10.1111/aphw.12288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
We investigated motivational regulation involving adjustment of recovery goals in post-stroke rehabilitation via standard in-clinic physiotherapy and in-home telerehabilitation (TR). We used a secondary dataset collected at 11 US sites as part of a clinical trial using video games and game control pads designed to induce certain arm movements required for recovery (n = 124; Mage = 61.44, SD = 13.30). Participants were randomly assigned to either the TR or in-clinic condition and underwent 36 therapy sessions, reporting on their activity-inherent enjoyment for 6-8 weeks. Compared with the in-clinic patients and TR patients with high game performance, TR patients with lower game performance reported lower activity-inherent enjoyment, which is an important motivational resource for successful recovery. The results suggest that these differences occur because TR patients become discouraged by low game score feedback, which may have signaled a poor prospect for recovery. However, the results also suggest that low game performers who successfully adjusted their recovery goals were resilient to the impact of low game score feedback on their motivational resources and satisfaction with therapy. The findings suggest that goal adjustment may be particularly beneficial when patients are discouraged by feedback indicating suboptimal recovery prospects.
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Affiliation(s)
- Yongwon Cho
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jeremy M Hamm
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - Jutta Heckhausen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA.,California Rehabilitation Institute, Los Angeles, CA, USA
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Ostrowska PM, Śliwiński M, Studnicki R, Hansdorfer-Korzon R. Telerehabilitation of Post-Stroke Patients as a Therapeutic Solution in the Era of the Covid-19 Pandemic. Healthcare (Basel) 2021; 9:654. [PMID: 34072939 PMCID: PMC8229171 DOI: 10.3390/healthcare9060654] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Due to the pandemic caused by the SARS-CoV-2 virus, rehabilitation centres have become less available for neurological patients. This is the result of efforts to physically distance society, to try to slow the spread of the pathogen. Health care facilities were mainly restricted to urgent cases, while most physiotherapy treatments, mainly for patients with chronic conditions, were suspended. Some countries have seen a reduction in acute stroke hospital admissions of from 50% to 80%. One solution to the above problem is the use of telerehabilitation in the home environment as an alternative to inpatient rehabilitation. (2) Aim of the study: The purpose of this review is to analyse the benefits and limitations of teletherapy in relation to the functional condition of post-stroke patients. (3) Methods: Selected publications from 2019 to 2021 on the telerehabilitation of stroke patients were reviewed. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. (4) Results: Studies have proven that teletherapy significantly improves the functional condition of post-stroke patients, resulting in improved quality of life and faster return to independence (while maintaining maximum possible precautions related to the SARS-CoV-2 virus pandemic). (5) Conclusions: Analysis of the study results showed comparable effectiveness of rehabilitation in the tele system to inpatient therapy. However, it should be emphasised that patients undergoing telerehabilitation must meet strict conditions to be eligible for this type of treatment program. However, the strength of the evidence itself supporting the effectiveness of this method ranks low due to the limited number of randomised control trials (RCT), small number of participants, and heterogeneous trials.
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Affiliation(s)
- Paulina Magdalena Ostrowska
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland; (M.Ś.); (R.S.); (R.H.-K.)
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Szczepańska-Gieracha J, Cieślik B, Rutkowski S, Kiper P, Turolla A. What can virtual reality offer to stroke patients? A narrative review of the literature. NeuroRehabilitation 2021; 47:109-120. [PMID: 32741792 DOI: 10.3233/nre-203209] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies demonstrated the efficacy of virtual reality (VR) as a method supporting the post-stroke neuro-rehabilitation process by activating motor learning processes. Nevertheless, stroke is frequently accompanied by serious psychological problems including depression, which is associated with an increased risk of mortality, lower post-stroke physical activity, and higher disability in stroke patients. OBJECTIVES To explore the current use of VR as a method supporting the neuro-rehabilitation process, both in physical and psychological dimensions. METHODS An exploratory review was conducted with a narrative synthesis. PubMed was used for literature search. Search includes the use of VR in physical rehabilitation, and as support therapy in psychiatric disorders. Both primary research and systematic reviews were included. RESULTS In neurological disorders rehabilitation, out of 22 studies, 16 concerned stroke survivors. In psychiatric disorders, 44 literature reviews were included. CONCLUSION The studies confirmed the effectiveness of various forms of VR treatment in the alleviation of psychological and behavioral problems and psychiatric disorders. There is a shortage of VR-based technological solutions that would, besides physical rehabilitation, offer stroke patients therapeutic tools to alleviate psychological disturbance and improve the patient's mood and motivation. Such solutions will most likely become a field of intensive research in the coming years.
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Affiliation(s)
| | - Błażej Cieślik
- Jan Dlugosz University in Czestochowa, Czestochowa, Poland
| | | | - Paweł Kiper
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy
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Kishimoto H, Yozu A, Kohno Y, Oose H. Nutritional improvement is associated with better functional outcome in stroke rehabilitation: A cross-sectional study using controlling nutritional status. J Rehabil Med 2020; 52:jrm00029. [PMID: 32052852 DOI: 10.2340/16501977-2655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the relationship between changes in nutritional status and the functional outcome of adult post-stroke patients hospitalized for rehabilitation. DESIGN A cross-sectional study. SUBJECTS Post-stroke patients (n = 134) who were admitted to a convalescent rehabilitation ward. METHODS On admission and discharge, the nutritional status of each subject was assessed using the "controlling nutritional status" system. Activities of daily living were assessed using the Functional Independence Measure (FIM). Patients were divided into 2 categories: (i) those whose nutritional status improved or remained normal during the rehabilitation; and (ii) all others. RESULTS The median age of patients was 65.5 years. Although there were no significant differences between the 2 categories in most characteristics, the FIM efficiency was significantly higher (0.230 in the improved category and 0.133 in the other; p < 0.001). Multiple linear regression analysis showed that the improved category as a variable was independently associated with greater FIM efficiency (p < 0.001). CONCLUSION Improvement or maintenance of nutritional status was associated with better functional recovery in post-stroke rehabilitation in adult patients of all ages.
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Jiang L, Dou ZL, Wang Q, Wang QY, Dai M, Wang Z, Wei XM, Chen YB. Evaluation of clinical outcomes of patients with post-stroke wrist and finger spasticity after ultrasonography-guided BTX-A injection and rehabilitation training. Front Hum Neurosci 2015; 9:485. [PMID: 26388761 PMCID: PMC4557080 DOI: 10.3389/fnhum.2015.00485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 08/21/2015] [Indexed: 11/20/2022] Open
Abstract
Objective: Using ultrasonography (US) to guide botulinum toxin type A (BTX-A) injection in patients with post-stroke wrist and finger flexor muscle spasticity and assessing clinical outcomes after the injection and rehabilitation intervention. Methods: Twenty-three patients with wrist and finger spasticity after stroke were recruited in this study from May 2012 to May 2013. Under US guidance, the proper dose (250 U) of BTX-A was injected into each spastic muscle at two injection sites. Then, conventional rehabilitation training started next day after BTX-A injection. The degree of spasticity was assessed by modified Ashworth scale (MAS) and wrist and finger motor function by active rang of movement (AROM), and Fugl-Meyer assessment (FMA) at the baseline, 1, 2, 4 and 12 weeks after BTX-A injection. Results: Significant decreases (p < 0.02) in the MAS scores of both the finger flexor muscle tone and wrist flexor muscle tone measured at 1, 2, 4, and 12 weeks after the BTX-A injection were found in comparison with the baseline scores. Compared with the baseline, the AROM values of the wrist and finger extensions and the FMA scores of the wrist and hand significantly increased (p < 0.02) at 2, 4 and 12 weeks after the BTX-A injection. Conclusions: US-guided BTX-A injection combined with rehabilitation exercise decrease spasticity of the wrist and finger flexor muscles and improve their motor function in stroke patients up to 12 weeks following BTX-A injection.
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Affiliation(s)
- Li Jiang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Zu-Lin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Qing Wang
- Institute of Medical Information, School of Biomedical Engineering, Southern Medical University Guangzhou, China
| | - Qiao-Yuan Wang
- Department of Ultrasound Medicine, The Third Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, MN, USA ; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic Rochester, MN, USA
| | - Xiao-Mei Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Ying-Bei Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University Guangzhou, China
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