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Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke
Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1–e102
tion during the stretching maneuver consequent to the decrease in muscle shortening, passive tension and stiffness. Data collection is ongoing to obtain long-term results on a wider sample. Keywords Spasticity; Functional surgery; Stiff knee gait Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.151 ISPR8-1160
Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke J.W. Hung 1,∗ , C.Y. Wu 2 , K.C. Chang 3 , Y.P. Pong 1 Chang Gung Memorial Hospital, Kaohsiung Medical Center, Rehabilitation, Kaohsiung, Taiwan R.O.C. 2 Chang Gung University, Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Taoyuan, Taiwan R.O.C. 3 Chang Gung Memorial Hospital, Kaohsiung Medical Center, Neurology, Kaohsiung, Taiwan R.O.C. ∗ Corresponding author. E-mail address: [email protected] (J.W. Hung)
1
Introduction/Background Spasticity, a common impairment after stroke, has profound negative impact on outcomes in patients with stroke. Botulinum toxin type A (BoNT-A) injection combined with rehabilitation training is suggested for spasticity treatment. However, there is no recommendation about what kind of rehabilitation training is more appropriate than others following BoNT-A injection. The purpose of this study was to compare the effects of combining BoNT-A injection with bilateral robot-assisted (RT) or mirror (MT) or task-oriented (TT) therapy for upper extremity (UE) spasticity in patients with chronic stroke. Material and method Participants were randomly assigned to RT, or MT, or TT group after BoNT-A injection. The participants received 45 minutes of intervention per day, 3 days/week, for 8 weeks according the allocated results. In addition, all participants received 30 minutes of functional practice training. At pre-intervention, post-intervention and 3-month follow-up a blinded research assistant did outcome measures, including body function and structures by Fugl-Meyer Assessment (FMA), and Modified Ashworth Scale (MAS); activity and participation measures by Motor Activity Log (MAL), and Nottingham Extended Activities of Daily Living Scale (EADLS). Results Thirty-seven subjects met the inclusion criteria and underwent randomization, 13 were assigned to the RT; 12 to MT; and 12 to TT group. The 3 groups were well matched with regard to baseline characteristics and functional status. All groups had significant improvement in FMA, MAS and MAL post-intervention. There were no group differences in FMA, MAS, EADLs either postintervention or at follow-up. There was a trend that TT group had higher quality of movement (QOM) in MAL post intervention than the other 2 groups (P = 0.07), at follow-up TT group had significantly higher QOM in MAL than the other 2 groups (P = 0.03). Conclusion Combining BoNT-A injection with TT resulted in better quality of UE movement in patients with spastic stroke than with RT or MT. Keywords Robot-assisted therapy; Mirror therapy; Task-oriented Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.152
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A7.06 Rehabilitation addressing to specific issues–Management of fatigue and sleep disorders ISPR8-0487
Cancer-related fatigue, a problem in and after oncological rehabilitation B. Leibbrand 1,∗ , H. Kähnert 2 , J. Maschke 2 Salzetalklinik, Onkologische Rehabilitation, Bad Salzuflen, Germany 2 Institut für Rehabilitationsforschung Norderney, Abt. Bad Salzuflen, Bad Salzuflen, Germany ∗ Corresponding author. E-mail address: [email protected] (B. Leibbrand)
1
Introduction/Background Cancer-related fatigue is the most distressing symptom of oncological patients with cancer-therapy, also in and after rehabilitation. The aim of our study was to adapt oncological rehabilitation to this symptom, so we developed and evaluated a fatigue-related management module called FaM-Modul for rehabilitation. Material and method The rehabilitation team developed and discussed the FaM-Modul. For study we used a sequential control group design with a control group (CG: n = 189) and an intervention group (IG: n = 194). Only participants with substantial fatigue-related problems in oncological rehabilitation were recruited. The effects of the FaM-Modul in the intervention group were evaluated by questionnaires asking for the fatigue-related therapies and fatiguerelated outcomes (MFI: general- (GF), physical- (PF), mental fatigue (MF); health-related quality of life (QoL-EORTC)) at the beginning (t1), the end (t2) and 3 months after oncological rehabilitation (t3). Non-parametric-tests and analysis of covariance with repeated measures were applied to investigate differences between CG and IG. Results The FaM-Modul consists additional to standard oncological rehabilitation of psychosocial, nutritional and exercise therapies. The IG evaluated both contents (P < 0.001) and organization (P < 0.001) better than the CG with standard oncological rehabilitation and they were more pleased with the fatiguetherapies (P < 0.001). There were improvements of the outcomes from t1 to t2 in both groups. However, from t1 to t3 the IG showed reductions in GF (P < 0.05), PF (P < 0.01) and MF (P < 0.01) and an increase in QoL (P < 0.01) compare to the CG. Conclusion Also standard oncological rehabilitation is successful to reduce fatigue-related symptoms of oncological patients in rehabilitation, but not after discharge. With a symptom-oriented module, developed by the rehabilitation team we can reduce fatigue-related symptoms until 3 months after discharge. The FaMModul completes standard rehabilitation therapies and supports rehabilitation. A controlled and multi-center study should be carried out to verify these results. Keywords Cancer-related fatigue; Oncological rehabilitation Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.153
tion during the stretching maneuver consequent to the decrease in muscle shortening, passive tension and stiffness. Data collection is ongoing to obtain long-term results on a wider sample. Keywords Spasticity; Functional surgery; Stiff knee gait Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.151 ISPR8-1160
Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke J.W. Hung 1,∗ , C.Y. Wu 2 , K.C. Chang 3 , Y.P. Pong 1 Chang Gung Memorial Hospital, Kaohsiung Medical Center, Rehabilitation, Kaohsiung, Taiwan R.O.C. 2 Chang Gung University, Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Taoyuan, Taiwan R.O.C. 3 Chang Gung Memorial Hospital, Kaohsiung Medical Center, Neurology, Kaohsiung, Taiwan R.O.C. ∗ Corresponding author. E-mail address: [email protected] (J.W. Hung)
1
Introduction/Background Spasticity, a common impairment after stroke, has profound negative impact on outcomes in patients with stroke. Botulinum toxin type A (BoNT-A) injection combined with rehabilitation training is suggested for spasticity treatment. However, there is no recommendation about what kind of rehabilitation training is more appropriate than others following BoNT-A injection. The purpose of this study was to compare the effects of combining BoNT-A injection with bilateral robot-assisted (RT) or mirror (MT) or task-oriented (TT) therapy for upper extremity (UE) spasticity in patients with chronic stroke. Material and method Participants were randomly assigned to RT, or MT, or TT group after BoNT-A injection. The participants received 45 minutes of intervention per day, 3 days/week, for 8 weeks according the allocated results. In addition, all participants received 30 minutes of functional practice training. At pre-intervention, post-intervention and 3-month follow-up a blinded research assistant did outcome measures, including body function and structures by Fugl-Meyer Assessment (FMA), and Modified Ashworth Scale (MAS); activity and participation measures by Motor Activity Log (MAL), and Nottingham Extended Activities of Daily Living Scale (EADLS). Results Thirty-seven subjects met the inclusion criteria and underwent randomization, 13 were assigned to the RT; 12 to MT; and 12 to TT group. The 3 groups were well matched with regard to baseline characteristics and functional status. All groups had significant improvement in FMA, MAS and MAL post-intervention. There were no group differences in FMA, MAS, EADLs either postintervention or at follow-up. There was a trend that TT group had higher quality of movement (QOM) in MAL post intervention than the other 2 groups (P = 0.07), at follow-up TT group had significantly higher QOM in MAL than the other 2 groups (P = 0.03). Conclusion Combining BoNT-A injection with TT resulted in better quality of UE movement in patients with spastic stroke than with RT or MT. Keywords Robot-assisted therapy; Mirror therapy; Task-oriented Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.152
e71
A7.06 Rehabilitation addressing to specific issues–Management of fatigue and sleep disorders ISPR8-0487
Cancer-related fatigue, a problem in and after oncological rehabilitation B. Leibbrand 1,∗ , H. Kähnert 2 , J. Maschke 2 Salzetalklinik, Onkologische Rehabilitation, Bad Salzuflen, Germany 2 Institut für Rehabilitationsforschung Norderney, Abt. Bad Salzuflen, Bad Salzuflen, Germany ∗ Corresponding author. E-mail address: [email protected] (B. Leibbrand)
1
Introduction/Background Cancer-related fatigue is the most distressing symptom of oncological patients with cancer-therapy, also in and after rehabilitation. The aim of our study was to adapt oncological rehabilitation to this symptom, so we developed and evaluated a fatigue-related management module called FaM-Modul for rehabilitation. Material and method The rehabilitation team developed and discussed the FaM-Modul. For study we used a sequential control group design with a control group (CG: n = 189) and an intervention group (IG: n = 194). Only participants with substantial fatigue-related problems in oncological rehabilitation were recruited. The effects of the FaM-Modul in the intervention group were evaluated by questionnaires asking for the fatigue-related therapies and fatiguerelated outcomes (MFI: general- (GF), physical- (PF), mental fatigue (MF); health-related quality of life (QoL-EORTC)) at the beginning (t1), the end (t2) and 3 months after oncological rehabilitation (t3). Non-parametric-tests and analysis of covariance with repeated measures were applied to investigate differences between CG and IG. Results The FaM-Modul consists additional to standard oncological rehabilitation of psychosocial, nutritional and exercise therapies. The IG evaluated both contents (P < 0.001) and organization (P < 0.001) better than the CG with standard oncological rehabilitation and they were more pleased with the fatiguetherapies (P < 0.001). There were improvements of the outcomes from t1 to t2 in both groups. However, from t1 to t3 the IG showed reductions in GF (P < 0.05), PF (P < 0.01) and MF (P < 0.01) and an increase in QoL (P < 0.01) compare to the CG. Conclusion Also standard oncological rehabilitation is successful to reduce fatigue-related symptoms of oncological patients in rehabilitation, but not after discharge. With a symptom-oriented module, developed by the rehabilitation team we can reduce fatigue-related symptoms until 3 months after discharge. The FaMModul completes standard rehabilitation therapies and supports rehabilitation. A controlled and multi-center study should be carried out to verify these results. Keywords Cancer-related fatigue; Oncological rehabilitation Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.153