Comparing The Effects Of Modified Constraint-induced Movement Therapy And Intensive Conventional Therapy On Upper-limb Motor Function Recovery After Botulinum-A Toxin Injection In Stroke

Background:Stroke is not only the second leading cause of mortality around the globe,but also one of the main causes of adult disability,which significantly decrease their quality of life(QOF).Thus,it brings various researches in order to find better ways to improve those patients' QOF.Many studies have suggested that the combination technique therapies show better outcomes compared with single approach.The injection of botulinum toxin type A(BTX-A)is recognized as an efficiency way to manage spasticity,and further prompts the recovery of motor function in stroke.Some studies have advised that BTX-A combined with modified constraint-induced movement therapy(BTX-m CIMT)or intensive conventional rehabilitation therapy(BTX-ICT)emerges as a highly promising intervention for motor recovery poststroke.Moreover,it should be noticed that the curative effects comparison of BTXm CIMT and BTX-ICT has not been reported previously in the literature.Objective:The present study is dedicated to determine whether there are any differences in therapeutic effects of BTX-m CIMT and BTX-ICT on stroke patients with upper extremity impairment,in order to explore the best way to facilitate motor recovery in stroke.Methods:58 cases of stroke were recruited from department of rehabilitation center of the First Hospital of Jilin University from February 2014 to November 2016,the age was between 10 and 70 years old,onset time from 2 weeks to 12 months.Total 32 participants met the inclusion criteria,then all of them had the injection of BTX-A.Later,they were randomly divided into two groups: intensive conventionalrehabilitation therapy(BTX-ICT),and modified constraint-induced movement therapy group(BTX-m CIMT).Both groups had the therapy for 1 hour a day,6 days a week,for 4 weeks.Motor function was assessed by the modified Ashworth scale(MAS),Fugl-Meyer Assessment of the upper extremity(FMA),and Barthel index(BI)before treatment and 4 weeks after treatment.Results:After 4-week treatment,both groups revealed a significant improvement in MAS,FMA and BI score compared with pre-treatment's(P < 0.05).BTX-m CIMT group possessed a noteworthy higher mean score in FMA and BI(the mean score of 52 and77.6 respectively)than BTX-ICT group's(the mean score of 37.5 and 70 respectively)(P < 0.05)at the end of 4 weeks' treatment,however,no significant statistical difference was seen in MAS score(P > 0.05).Conclusion:Both BTX-m CIMT and BTX-ICT can facilitate motor function recovery in stroke.Compared with BTX-ICT,BTX-m CIMT shows better curative effects on motor function recovery and daily living ability.