脳卒中慢性期の上肢痙性片麻痺に対する促通反復療法とボツリヌス治療の併用効果に関する検討 : ランダム化比較試験

• Material Type: 博士論文
• Title: 脳卒中慢性期の上肢痙性片麻痺に対する促通反復療法とボツリヌス治療の併用効果に関する検討 : ランダム化比較試験
• Author/Editor: 外薗, 昭彦
• Author Heading: 外薗, 昭彦 ホカゾノ, アキヒコ
• Publication, Distribution, etc.: Elsevier
• Alternative Title: Combination therapy with Repetitive Facilitative Exercise Program and Botulinum Toxin Type A to improve motor function for the upper-limb spastic paresis in Chronic Stroke : A Randomized Controlled Trial
• Degree grantor/type: 鹿児島大学
• Date Granted: 2021-05-06
• Dissertation Number: 甲総研第606号
• Degree Type: 博士(医学); Doctor of Philosophy in Medical Science
• Text Language Code: eng
• Subject Heading: Stroke; Rehabilitation; Hemiplegia; Muscle spasticity; Botulinum toxin; Exercise therapy
• Target Audience: 一般
• Note (General): 博士論文全文, 博士論文要旨, 最終試験結果の要旨, 論文審査の要旨; Study design: An open-label, randomized, controlled, observer-blinded trial. Introduction: Repetitive facilitative exercise (RFE) is a movement therapy to recover from hemiparesis after stroke. However, improvement is inhibited by spasticity. Recently, botulinum toxin type A (BoNT-A) injection has been shown to reduce spasticity. Purpose: To examine the combined effect of an RFE program and BoNT-A treatment on upper-limb spastic paresis in chronic stroke. Methods: Forty chronic stroke inpatients with upper-limb spastic paresis (Brunnstrom stage ≥III and Modified Ashworth Scale [MAS] score ≥1) were enrolled. Subjects were randomized into 2 groups of 20 each and received 4 weeks of treatment. The intervention group received RFE and BoNT-A injection; the control group underwent RFE only. Assessments were performed at baseline and at study conclusion. The primary outcome was change in Fugl–Meyer Assessment score for the upper extremity (FMA). The Action Research Arm Test (ARAT), active range of motion, Box and Block Test, and MAS were also evaluated. Results: All participants completed this study. After 4 weeks, the intervention group evidenced a significantly greater increase in FMA score (median 11.0 [range 4-20]) than the control group (median 3.0 [range 0-9]) (P < .01, r = 0.79); as well as improvements in the other measures such as ARAT (median 12.5 [range 4-22] vs 7 [0-13]) (P < .01, r = 0.6), and MAS in the elbow flexors (median −1.5 [range −2 to 0] vs −1 [−2 to 0]) (P < .01, r = 0.45). Discussion: A high degree of repetitive volitional movement induced by the facilitative technique with concomitant control of spasticity by BoNT-A injection might increase efficiency of motor learning with continuous movement of the affected upper-limb. Conclusions: The combination of RFE and BoNT-A for spastic paresis might be more effective than RFE alone to improve upper-limb motor function and to lessen impairment in chronic stroke. Akihiko Hokazono, Seiji Etoh, Yuiko Jonoshita, Kazumi Kawahira, Megumi Shimodozono Combination therapy with repetitive facilitative exercise program and botulinum toxin type A to improve motor function for the upper-limb spastic paresis in chronic stroke: A randomized controlled trial Journal of Hand Therapy 2021 https://doi.org/10.1016/j.jht.2021.01.005
• Format (IMT): application/pdf
• Source: Diss_外薗_昭彦_ISK606_2021 （fulltext）; https://ir.kagoshima-u.ac.jp/record/15871/files/Diss_%E5%A4%96%E8%96%97_%E6%98%AD%E5%BD%A6_ISK606_2021.pdf
• Access Restrictions: インターネット公開
• Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• Original Data Provider (Database): 鹿児島大学 : 鹿児島大学リポジトリ