P1-15-06. The effect of combination of Neuromuscular Electrical Stimulation and botulinum toxin injection in chronic stroke patients

Background: Walking ability is important in stroke patients to maintain daily life. Nevertheless, its improvement is limited with conventional physical therapy in chronic stage. We report the case of a chronic stroke patient showing a remarkable improvement in gait function after a new neurorehabilitation protocol using transcranial direct current stimulation (tDCS) and neuromuscular electrical stimulation (NMES). Case Presentation: A 62-year-old male with left putaminal hemorrhage suffered from severe right hemiparesis. He could move by himself with a wheelchair 1 year after the ictus. Anodal tDCS at the vertex (2 mA, 20 min) with NMES at the anterior tibialis muscle had been applied for 3 weeks. The Timed Up and Go test and 10-meter walk test improved after the intervention, which had been maintained for at least 1 month. Conclusion: This single case suggests the possibility that tDCS with NMES could be a new rehabilitation approach to improve the gait ability in chronic stroke patients.

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EP 5. Decrement of the effect of neuromuscular electrical stimulation over time in chronic stroke patients

Clinical Neurophysiology ◽

10.1016/j.clinph.2016.05.061 ◽

2016 ◽

Vol 127 (9) ◽

pp. e234-e235

Author(s):

F. Quandt ◽

J. Feldheim ◽

J.C. Loitz ◽

D. Wolff ◽

M. Rohm ◽

...

Keyword(s):

Electrical Stimulation ◽

Neuromuscular Electrical Stimulation ◽

Chronic Stroke ◽

Stroke Patients ◽

Over Time

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Effects of repetitive facilitative exercise with neuromuscular electrical stimulation, vibratory stimulation and repetitive transcranial magnetic stimulation of the hemiplegic hand in chronic stroke patients

International Journal of Neuroscience ◽

10.3109/00207454.2015.1094473 ◽

2015 ◽

Vol 126 (11) ◽

pp. 1007-1012 ◽

Cited By ~ 6

Author(s):

Seiji Etoh ◽

Tomokazu Noma ◽

Yuko Takiyoshi ◽

Michiko Arima ◽

Rintaro Ohama ◽

...

Keyword(s):

Electrical Stimulation ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Neuromuscular Electrical Stimulation ◽

Chronic Stroke ◽

Vibratory Stimulation ◽

Stroke Patients ◽

Stimulation Of

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Botulinum Toxin Injections and Electrical Stimulation for Spastic Paresis Improve Active Hand Function Following Stroke

Toxins ◽

10.3390/toxins10110426 ◽

2018 ◽

Vol 10 (11) ◽

pp. 426 ◽

Cited By ~ 3

Author(s):

Jong-Min Lee ◽

Jean-Michel Gracies ◽

Si-Bog Park ◽

Kyu Lee ◽

Ji Lee ◽

...

Keyword(s):

Electrical Stimulation ◽

Botulinum Toxin ◽

Muscle Tone ◽

Hand Function ◽

Botulinum Toxin Type A ◽

Chronic Stroke ◽

Test Results ◽

Wrist Flexion ◽

Stroke Patients ◽

Wrist Flexors

Botulinum toxin type A (BTX-A) injections improve muscle tone and range of motion (ROM) among stroke patients with upper limb spasticity. However, the efficacy of BTX-A injections for improving active function is unclear. We aimed to determine whether BTX-A injections with electrical stimulation (ES) of hand muscles could improve active hand function (AHF) among chronic stroke patients. Our open-label, pilot study included 15 chronic stroke patients. Two weeks after BTX-A injections into the finger and/or wrist flexors, ES of finger extensors was performed while wearing a wrist brace for 4 weeks (5 days per week; 30-min sessions). Various outcomes were assessed at baseline, immediately before BTX-A injections, and 2 and 6 weeks after BTX-A injections. After the intervention, we noted significant improvements in Box and Block test results, Action Research Arm Test results, the number of repeated finger flexions/extensions, which reflect AHF, and flexor spasticity. Moreover, significant improvements in active ROM of wrist extension values were accompanied by marginally significant changes in Medical Research Council wrist extensor and active ROM of wrist flexion values. In conclusion, BTX-A injections into the finger and/or wrist flexors followed by ES of finger extensors improve AHF among chronic stroke patients.

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Novel Neuromuscular Electrical Stimulation System for the Upper Limbs in Chronic Stroke Patients

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0000000000000056 ◽

2014 ◽

Vol 93 (6) ◽

pp. 503-510 ◽

Cited By ~ 15

Author(s):

Tomokazu Noma ◽

Shuji Matsumoto ◽

Megumi Shimodozono ◽

Yoshiaki Iwase ◽

Kazumi Kawahira

Keyword(s):

Electrical Stimulation ◽

Neuromuscular Electrical Stimulation ◽

Chronic Stroke ◽

Upper Limbs ◽

Stroke Patients ◽

Stimulation System

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Feasibility of single and combined with other treatments using transcranial direct current stimulation for chronic stroke: A pilot study

SAGE Open Medicine ◽

10.1177/2050312120940546 ◽

2020 ◽

Vol 8 ◽

pp. 205031212094054

Author(s):

Koichi Hyakutake ◽

Takashi Morishita ◽

Kazuya Saita ◽

Toshiyasu Ogata ◽

Yoshinari Uehara ◽

...

Keyword(s):

Electrical Stimulation ◽

Botulinum Toxin ◽

Pilot Study ◽

Transcranial Direct Current Stimulation ◽

Pediatric Patients ◽

Botulinum Toxin A ◽

Neuromuscular Electrical Stimulation ◽

Chronic Stroke ◽

Group I

Objectives: This pilot study aimed to investigate the safety and efficacy of transcranial direct current stimulation (tDCS) for chronic stroke in adult and pediatric patients. We also aimed to verify the efficacy of botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy involving bilateral tDCS in adult patients with chronic stroke. Methods: We conducted a pilot study applying an unblinded, non-randomized design. Eleven patients were recruited, and classified into three groups. Group I-a involved bilateral transcranial direct current stimulation and intensive occupational therapy for chronic stroke in adult patients. Group I-b involved bilateral tDCS and intensive occupational therapy for chronic stroke in pediatric patients. Group II involved bilateral tDCS, peripheral neuromuscular electrical stimulation, and intensive occupational therapy after botulinum toxin A injection for chronic stroke in adult patients. Clinical evaluations to assess motor function and spasticity were performed at baseline as well as in 2-week and 4-month follow-up visits. The questionnaire included questions regarding the presence of tDCS side effects, such as headache, redness, pain, itching, and fever. Results: There were clinically meaningful changes in total Fugl–Meyer Assessment Upper Extremity (FMA-UE) scores at the 2-week follow-up and in the Action Research Arm Test (ARAT) scores at 4-month follow-up in Group I-b. In addition, Group II showed significant improvement in total FMA-UE scores in the 2-week follow-up (p < 0.05) but not on the ARAT scores (p > 0.05). However, Group II showed improvements in total Motor Activity Log scores at both follow-up visits (p < 0.05). No serious adverse events were reported. Conclusion: The results of this study indicate that tDCS therapy is a potential treatment in pediatric patients with chronic stroke. Furthermore, our data indicate that botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy may enhance the efficacy of tDCS on motor function.

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Ultrasonographic Evaluation of Botulinum Toxin Injection Site for the Medial Approach to Tibialis Posterior Muscle in Chronic Stroke Patients with Spastic Equinovarus Foot: An Observational Study

Toxins ◽

10.3390/toxins9110375 ◽

2017 ◽

Vol 9 (11) ◽

pp. 375 ◽

Cited By ~ 1

Author(s):

Alessandro Picelli ◽

Alessio Baricich ◽

Elena Chemello ◽

Nicola Smania ◽

Carlo Cisari ◽

...

Keyword(s):

Botulinum Toxin ◽

Injection Site ◽

Botulinum Toxin Injection ◽

Muscle Thickness ◽

Chronic Stroke ◽

Tibialis Posterior ◽

Anatomical Landmarks ◽

Echo Intensity ◽

Stroke Patients ◽

Medial Approach

The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: tibialis posterior muscle depth, thickness, and echo intensity. As to the spastic tibialis posterior, we found a mean muscle depth of 26.5 mm and a mean muscle thickness of 10.1 mm. Furthermore we observed a median tibialis posterior muscle echo intensity of 3.00 on the Heckmatt scale. The tibialis posterior muscle thickness was found to be inversely associated with its depth (p < 0.001) and echo intensity (p = 0.006). Furthermore, tibialis posterior muscle depth was found to be directly associated with its echo intensity (p = 0.004). Our findings may usefully inform manual needle placement into the tibialis posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.

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