Authors (including presenting author) :
Yeung EMP(1),Cheung P(2),Lee TH(1),Chung R(2),Cheng YY(1),Lam YF(1),Chung KYK(1),Fong GCH(1),Ho MK(1),To J(2),Mo MM(1), Chan D(2),Yu TKK(1)
Affiliation :
(1)Department of Rehabilitation, Kowloon Hospital,(2)Department of Occupational Therapy, Kowloon
Introduction :
About 30% of stroke patients may develop spasticity. Botulinum toxin therapy (BoNT) and Repetitive Transcranial Magnetic Stimulation (rTMS) may improve the spastic muscles. Case series on using these interventions for stroke spasticity management in Kowloon Hospital (KH) were presented.
Objectives :
To evaluate the effectiveness of 1) first and second usage of BoNT in spasticity; 2) rTMS for motor stroke rehabilitation with spasticity.
Methodology :
Retrospective self- control case series were conducted. The inclusion criteria for BoNT and rTMS were 1) cerebral infarction or hemorrhage; 2) Age >18; 3) no absolute contraindications to receive BoNT and rTMS respectively. Both groups of patients had the interventions in KH and followed by occupational therapist applied intensive stretching of spastic flexors and activation of extensors to enhance more functional use of upper limb.
The primary outcome measures were: 1) active range of movement (AROM); 2) passive range of movement (PROM); 3) Tardieu’s scale in V3. The secondary outcomes were: 1) Functional Test of Hemiplegic in Upper Extremity level –Hong Kong version (FTHUE) 2) Fugl-Meyer Assessment (FMA) subscores.
Result & Outcome :
From 2011 to 2019, 34 patients received the first injection of BoNT and 8 patients required the second injection. In the first injection group, Tardieu’s scale, AROM, PROM and FTHUE were improved at post injection 4 and 24 weeks. The initial spasticity before the injection correlated with better spasticity control. The correlation coefficient between initial spasticity and post 24-week spasticity over pectoralis major was 0.441 (p=0.009). For pronator and wrist flexors, the pre-injection spasticity was correlated with the improvement of 24-week first catch angle (0.634, p=0.000 and 0.437, p=0.010 respectively). No improvement was found on the upper limb spasticity and FTHUE in second injection group.
From 2015 to 2020, 23 patients received rTMS for stroke motor rehabilitation with spasticity. rTMS improved the spasticity over the shoulder external rotation (p=0.004) and elbow flexion (p=0.034) 4-weeks after rTMS. After 12-weeks of rTMS, the spasticity of upper limb was improved (shoulder flexion p=0.014, shoulder external rotation p=0.004, elbow flexion p=0.020, forearm pronation p=0.046 and wrist extension p=0.011). For the secondary outcome, the FTHUE, FMA subscores were improved at 4-weeks and 12-weeks after rTMS together with occupational therapy.
First injection of BoNT and rTMS can improve spasticity among stroke patients in rehabilitation.
