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Japanese Occupational Therapy Research Volume 32, Issue 3 （June 2013）

作業療法 32巻3号（2013年6月発行）

Japanese English

◆研究論文

脳卒中後の重度痙性上肢麻痺に対するボツリヌス毒素投与と低周波治療，作業療法士による自主トレーニング指導との併用療法―～パイロット研究～ Efficacy of Botulinum toxin type A injections combined with occupational therapy and low frequency wave electrical stimulation for spastic upper limb hemiparesis after stroke 佐瀬洋輔 ¹ , 池ヶ谷正人 ¹ , 小澤弘幸 ¹ , 角田亘 ² , 安保雅博 ² Yousuke Sase ¹ , Masato Ikegaya ¹ , Hiroyuki Ozawa ¹ , Wataru Kakuda ² , Masahiro Abo ² ¹東京慈恵会医科大学附属病院リハビリテーション科 ²東京慈恵会医科大学リハビリテーション医学講座 ¹Department of Rehabilitation Medicine, Jikei University Hospital ²Department of Rehabilitation Medicine, Jikei University School of Medicine キーワード：（ボツリヌス毒素） , （痙性上肢麻痺） , 機能的電気刺激 , （自主トレーニング） , Botulinum toxin type A , Spastic upper limb hemiparesis after stroke , Functional electrical stimulation , Home-based functional training Keyword: （ボツリヌス毒素） , （痙性上肢麻痺） , 機能的電気刺激 , （自主トレーニング） , Botulinum toxin type A , Spastic upper limb hemiparesis after stroke , Functional electrical stimulation , Home-based functional training pp.233-243

発行日 2013年6月15日 Published Date 2013/6/15

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要旨：脳卒中後の痙性上肢麻痺に対しA型ボツリヌス毒素（Botulinum toxin type A；以下，BoNT-A）投与の臨床的効果は，痙性軽減や上肢機能改善などの報告があり，麻痺側部位の機能再建や随意性改善などの治療法に低周波治療があるがBoNT-Aと低周波治療の併用療法の報告はあまり見られない．本研究では，重度痙性上肢麻痺患者に対しBoNT-A投与と低周波治療，自主トレーニング指導の併用という取り組みの効果と安全性を検討した結果，BoNT-A投与4週間後に改訂Ashworthスケールと関節可動域，Fugl-Meyer Assessment，Wolf Motor Function Testで有意な改善を認め，重篤な副作用なく受動的・能動的動作の向上に一定の効果を得た．

　Background: Botulinum toxin type A (BoNT-A) has been reported to be an effective treatment for spastic upper limb hemiparesis after stroke, such as mitigation of spasticity, and improvement of upper limb function. Low frequency wave electrical stimulation is a secondary therapy to improve voluntary to spastic upper limb hemiparesis after stroke. This study examines the effect and safety of BoNT-A injections combined by low frequency wave electrical and home-based functional training for spastic upper limb hemiparesis after stroke.

　Subjects and Methods: The subjects were 32 patients with spastic upper limb hemiparesis after stroke (age at intervention: 53.0±10.8 years; time after onset: 62.1±48.9 months;subtype of stroke: intracerebral hemorrhage, n=26;cerebral infarction, n=6). Using the Modified Ashworth Scale (MAS), the Fugl-Meyer Assessment Scale (FMA), the Wolf Motor Function Test (WMFT), and the Jikei Assessment Scale for Motor Impairment in Daily Living (JASMID), we evaluated the EQ5D on the day of the BoNT-A injection and 4 weeks after injection. On the day of injection, we instructed the patient in self-training and living guidance. Instruction of low frequency wave electrical stimulation was provided in person and in writing.

　Results: Four weeks after injection, all patients showed improvements in the MAS, the total score, FMA, and the WFMT (all ＜ .05). There were no serious side effects.

　Conclusion: Combined therapeutic approach of BoNT-A injections, self-training instructions such as stretching and low frequency wave electrical stimulation is an effective intervention without critical side effects.