A Treatment Of Botulinum Toxin Type A Injection Combine With Orthoses For Patients Of Equinovarusafter Stroke

Objective：After the injury of central nervous system, the restrain of upper motorneuron to lower motor neuron is to weaken, which leads to the hyperthyroidism oflower motor neuron and muscle tension obstacles. Long-term muscle spasms in tendonsand the joint contracture, and make the body musculoskeletal system presents staticdeformity, The pathological changes of musculoskeletal system will closed theabnormal movement within the scope of the itself, thus it creats a vicious circlebetween the irregular movement pattern with static contracture and deformation.According to the movement of neurons in muscle spasm too excited, Botulinum toxinselective roles around in motor-muscle joints, and restrains the release of neuralmedium acetylcholine of presynaptic membrane, so it can relax the muscle andalleviate the spasm. For the static contracture caused by long-term muscle spasms，theorthoses can play certain role in extending contracture organization and fixing the out ofcontrol joint action.The spasmolysis effect of Botulinum toxin is reversible. How to extend itsspasmolysis effect and make full use of it for more improvement on the functionbecome the focus at present. After long-term physical deformities, muscle spasms andstatic contracture often coexist in stroke patients. This study gave the treatment ofBotulinum toxin type A injection to the stroke patients with obviously equinovarushemiplegia. We compared the spasm effect of Botulinum toxin type A injectioncombine with orthoses treatment with simple Botulinum toxin type A injections, andanalysised its effect to the recovery of walking function.Methods:24stroke patients with obvious equinovarus were selected, and randomlydivided into treatment group and control group. Each group was of12patients. The treatment group were injected Botulinum toxin type A combined with orthosestreatment and then done rehabilitation training. The control group were only injectedBotulinum toxin type A combined with routine rehabilitation training. The spasmeffect of Botulinum toxin lasts3~4months generally. This research and treatmentlasted for16weeks. With Modified Ashworth Scale (MAS) assessed the spasm effect.With Fugl-Meyer Assessment(FMA),pace and step length measurement resultsassessed the Walking function.Results:1.General view: During treatment all patients did not appear obviousadverse reaction, Only two patients suffered with pain of injection points. Withoutspecial processing, the short term to ease.2.MAS score: After treatment for2weeks and4weeks, MAS scores of treatmentgroup and control group both significantly decreased than before treatment (P＞0.05).The MAS scores between the two groups have no obvious difference (P＞0.05). After12weeks of treatment the MAS scores of the two groups both increased. The MASscores of control group increased more obviously, but it still had statistical significancethan before treatment (P＜0.05). The muscle tension of treatment group rose relativelyslow, MAS scores had remarkable statistical significance than before treatment (P＜0.0)1. Then the MAS scores between two groups had statistically significant differences(P <0.05). After16weeks treatment, the muscle tension of control group went back tothe basic level, and the MAS scores had no statistically significant differences thanbefore (P＞0.05). The muscle tension of treatment group increased too, however it stillretained certain spasm effect. The MAS score still had statistical significance thanbefore treatment (P＜0.05). Meanwhile the MAS scores between the two groups hadstatistically significant differences (P＜0.05).3.The FMA assessment and measurement result of step and pace between the twogroups: After treatment for2weeks and4weeks, the FMA assessment andmeasurement result of step and pace had no statistically significant differences betweenthe two groups (P＜0.05). However they had statistically significant differencesbetween the two groups (P＜0.05). After treatment for12weeks and16weeks.4.The MAS scores, FMA assessment and measurement result of step and paceof the two groups after16weeks treatment and before treatment: After16weekstreatment, the muscle tension of control group went back to the basic level, but theMAS scores had no statistically significant differences than before (P＜0.05). Themuscle tension of treatment group also increased, but still retained the certain spasm effect. The MAS score had statistical significance than before treatment (P＜0.05).After treatment for16weeks, the FMA assessment and the measurement results of stepand pace of the two groups both significantly increased han before treatment (P＜0.01).Conclusion: Botulinum toxin type A injection can be effective, fast, and temporaryto reduce the muscle spasm after stroke. It can effectively improve the function ofmuscle to combine rehabilitation training meanwhile. For the static contracture causedby long-term muscle spasms, the orthoses can extend contracture organization and fixthe out of control joint action. So in this study the spasmolysis effect relatively stableand enduring and function improvement is more obvious when combinedBotulinum toxin type A injection with orthoses treatment.