Association of Long-Term Treatment by Botulinum Neurotoxins and Occupational Therapy with Subjective Physical Status in Patients with Post-Stroke Hemiplegia

Abstract

The short-term effects of botulinum toxin type A (BoNT-A) treatment in stroke patients with upper limb extremity are well established. This study examined the association between the recovery of motor function of the upper extremity with subjective physical symptoms in outpatients receiving long-term BoNT-A and occupational therapy following stroke. We also investigated the expectations of patients who elected to continue treatment. Forty-seven patients (23 men and 24 women) aged 61 years received BoNT-A treatment more than 20 times. The subjective physical status was analyzed by using the visual analogue scale score through an eight-item questionnaire. Recovery of motor function in the upper extremity was detected by calculating the change (delta) in Fugl–Mayer Assessment (FMA), and ordinal logistic modeling analysis was used to determine the association between the delta-FMA score and the subjective level of agreement for each item. When the ordinal logistic modeling fit was statistically significant, results were interpreted as having logistic probability. The logistic curves discriminating one point (strongly disagree) from five points (strongly agree) were fit in a stepwise fashion. This study suggests that patients receiving long-term BoNT-A treatment and occupational therapy experienced an increased upper extremity mitigation and decreased insomnia after injection, regardless of the recovery of motor function.

Changes in motor paralysis involving upper extremities of outpatient chronic stroke patients from temporary rehabilitation interruption due to spread of COVID-19 infection: An observational study on pre- and post-survey data without a control group

“…BoNT-A is an effective treatment for reducing spasticity in patients with stroke [ 28 , 29 ]. It has also been reported to be effective in improving insomnia and relieving pain for patients who have continued treatment for a long period [ 30 ]. It is of concern that decreased upper limb motor function and subjective symptoms may occur in patients who could not be injected with BoNT-A, as the effect of BoNT-A is maintained for only approximately 3 months after injection [ 31 , 32 ].…”

Long-Term Enhancement of Botulinum Toxin Injections for Post-Stroke Spasticity by Use of Stretching Exercises—A Randomized Controlled Trial

“…Following these studies, two papers related to BoNT-A and upper-limb motor function recovery were published [ 35 , 38 ]. Hamaguchi et al [ 38 ] examined the association between the recovery of upper-limb motor function and subjective symptoms such as muscle relaxation and pain after treatment in patients who continued BoNT-A treatment and upper-limb exercise therapy for more than five years after a stroke, suggesting that long-term BoNT-A treatment can improve the subjective symptoms of insomnia and motor weakness caused by stroke sequelae and reduce pain without the recovery of upper-limb motor function [ 38 ].…”

“…Following these studies, two papers related to BoNT-A and upper-limb motor function recovery were published [ 35 , 38 ]. Hamaguchi et al [ 38 ] examined the association between the recovery of upper-limb motor function and subjective symptoms such as muscle relaxation and pain after treatment in patients who continued BoNT-A treatment and upper-limb exercise therapy for more than five years after a stroke, suggesting that long-term BoNT-A treatment can improve the subjective symptoms of insomnia and motor weakness caused by stroke sequelae and reduce pain without the recovery of upper-limb motor function [ 38 ]. Hung et al [ 35 ] performed a study to explore the predictors of clinically important changes in active motor function and the daily use of the affected upper limb following BoNT-A injection for upper-extremity spasticity after a stroke, reporting that patients less than 36 months post stroke were more likely to achieve a clinically significant improvement in upper-limb motor function.…”

Editorial: Transitional and long-term continuous care & rehabilitation after stroke

“…Post-stroke spasticity is associated with complications such as contractures pressure ulcers or pain and poor quality of life (18,19). Adequate treatments for spasticity can improve patient function and quality of life (20,21). Zhang et al conducted a multicenter randomized controlled trial to investigate the effect of dry needling at the myofascial trigger point (30 min in each session for a total of five sessions for 4 weeks) on hand spasticity in 210 patients with chronic stroke.…”