[PA-2-1] “Wishing to walk beautifully with swinging my arms”
<Background and aim>
According to Japanese Guidelines for the Management of Stroke 2021, treatment options such as training using robots, repetitive transcranial magnetic stimulation (rTMS), electrical stimulation therapy, and training using virtual reality have increased in recent years, in addition to conventional training. And then incorporating them into occupational therapy is becoming routine.
An intervention to wear the Integrated Volitional Control Electrical stimulator (IVES) for a long period of time led to suppress spasticity during movement which led the improvement of arm swing during gait, and the progress is reported here.
<Method>
81-year-old female, right-handed, The consciousness disturbance and right hemiplegia developed while shopping. Brought to an emergency hospital and was diagnosed with hypertensive left putaminal hemorrhage. Admitted to the convalescent rehabilitation ward 21 days after onset.
Fugl-Meyer Assessment of upper extremity (FMA-UE):10,Modified Ashworth Scale (MAS):elbow1, Functional Independence Measure(FIM):54/126.
Due to aphasia, difficulty in understanding and expression.
IVES is adopted to facilitate function and improve Activities of Daily living, since the early days of hospitalization. After two months of hospitalization, High-Frequency rTMS(HF-rTMS) and intensive occupational therapy were performed.
FMA-UE:38→44/66, MAS:elbow2→1+, finger2→1+, Motor Activity Log(MAL):AOU0.79→1.71, QOM0.79→1.71, FIM:77→93/126.Speech difficulty remained.
Improvement in function and ability level was observed. Nevertheless, due to spasticity during movement, particular to the elbow and finger flexor muscles, it hindered such hope as "wishing to walk beautifully with swinging my arms". Therefore, it was attempted to wear IVES for 8 hours a day for 15 days with the triceps brachii as target muscle. In addition, when reaching, recalling the movement image as much as possible was urged.
<Results>
FMA-UE:48→51/66,MAS:elbow1+→1,finger1+→1,MAL:AOU2.14→3.07,QOU2.00→2.64,
FIM:93→104/126.
Although spasticity during movement was still observed but mitigated, therefore she could swing arms during gait than before.
<Discussion>
It was attempted to promote the output of antagonistic muscles by wearing the IVES for a long period of time in order to suppress spasticity by reciprocal inhibition. It is speculated that not only simple repetitive movements but also performing actual daily activities while having an image of movement led to spasticity management, which brought improvements in arm swing during gait.
In addition, HF-rTMS is also considered to be useful for spasticity, and the frequency of use of the paretic hand is important to enhance its effect, which is associated with long-term improvement in acute and chronic upper extremity function. Therefore, we would like to explore the appropriate introduction timing and combination in hybrid therapy so that better effects can be obtained for future clients.
According to Japanese Guidelines for the Management of Stroke 2021, treatment options such as training using robots, repetitive transcranial magnetic stimulation (rTMS), electrical stimulation therapy, and training using virtual reality have increased in recent years, in addition to conventional training. And then incorporating them into occupational therapy is becoming routine.
An intervention to wear the Integrated Volitional Control Electrical stimulator (IVES) for a long period of time led to suppress spasticity during movement which led the improvement of arm swing during gait, and the progress is reported here.
<Method>
81-year-old female, right-handed, The consciousness disturbance and right hemiplegia developed while shopping. Brought to an emergency hospital and was diagnosed with hypertensive left putaminal hemorrhage. Admitted to the convalescent rehabilitation ward 21 days after onset.
Fugl-Meyer Assessment of upper extremity (FMA-UE):10,Modified Ashworth Scale (MAS):elbow1, Functional Independence Measure(FIM):54/126.
Due to aphasia, difficulty in understanding and expression.
IVES is adopted to facilitate function and improve Activities of Daily living, since the early days of hospitalization. After two months of hospitalization, High-Frequency rTMS(HF-rTMS) and intensive occupational therapy were performed.
FMA-UE:38→44/66, MAS:elbow2→1+, finger2→1+, Motor Activity Log(MAL):AOU0.79→1.71, QOM0.79→1.71, FIM:77→93/126.Speech difficulty remained.
Improvement in function and ability level was observed. Nevertheless, due to spasticity during movement, particular to the elbow and finger flexor muscles, it hindered such hope as "wishing to walk beautifully with swinging my arms". Therefore, it was attempted to wear IVES for 8 hours a day for 15 days with the triceps brachii as target muscle. In addition, when reaching, recalling the movement image as much as possible was urged.
<Results>
FMA-UE:48→51/66,MAS:elbow1+→1,finger1+→1,MAL:AOU2.14→3.07,QOU2.00→2.64,
FIM:93→104/126.
Although spasticity during movement was still observed but mitigated, therefore she could swing arms during gait than before.
<Discussion>
It was attempted to promote the output of antagonistic muscles by wearing the IVES for a long period of time in order to suppress spasticity by reciprocal inhibition. It is speculated that not only simple repetitive movements but also performing actual daily activities while having an image of movement led to spasticity management, which brought improvements in arm swing during gait.
In addition, HF-rTMS is also considered to be useful for spasticity, and the frequency of use of the paretic hand is important to enhance its effect, which is associated with long-term improvement in acute and chronic upper extremity function. Therefore, we would like to explore the appropriate introduction timing and combination in hybrid therapy so that better effects can be obtained for future clients.