Effect of Combining Botulinum Toxin Type a Injection with Different Robot-Assisted Gait Training Programs on Walking Ability in Patients with Stroke

  • Tang, Fuk-Tan (PI)

Project: National Science and Technology CouncilNational Science and Technology Council Academic Grants

Project Details


Ambulation is an important part of neurorehabilitation. Walking after stroke is characterized by slow gait speed, poor endurance, and a reduced ability to adapt to the task and the environmental constraints. Positive features of stroke that include hyperreflexia, spasticity, dystonia and enhanced sensitivity to nociceptive input. Chemodenervation with botulinum toxin type A(BTX-A)have been shown to be effective at reducing post-stroke foot and ankle spasticity, while improving the motor control capability.Robotic-assisted gait training(RAGT) have shown positive effects on post-stroke gait pattern. Therefore, the aim of this study is to investigate if combined use of BTX-A and RAGT can improve the outcome of walking ability in stroke patients with hemiplegic gait. In this study we are going to test three hypotheses: 1. The patients who received BTX-A and robotic gait training will get better outcome than those who received BTX-A and conventional gait training. 2. The patients who received BTX-A and CIMT mode RAGT will get better gait symmetricity than those who received regular robotic gait training. 3. The patients who received BTX-A and active RAGT with PCRCT will have better gait performance than those who received full guidance mode(robotic gait training)RAGT The BTX-A was performed under echo-guided and electrical stimulation guided injection. Lokomat will be applied for robotic gait training. Totally 4 weeks training will be given to each tested subject. The training frequency was 3 times per week and 30 minutes per session. A battery of test including 10 meter walking test, lower extremity Fugl-Meyer assessment and polyelectromyography during walking will be examined before intervention and at 4 weeks, 8 weeks and 12 weeks after intervention. This three year project will be conducted in Linkou and Taoyuan Chang Gung Memorial Hospital. Forty stroke patients with Functional Ambulation classification grade 3 or more than grade 3 will be recruited each year. They will be devided into two groups. In group A, FAC grade 3 and grade 4 (dependent walking) will be enrolled. FAC grade 5 and grade 6 (independent walking) will be enrolled into group B. In the first year, BTX-A and traditional gait training for the control group will be given and the experimental group will receive BTX-A and RAGT. In the second year, the control group will receive RAGT in Constraint-Induced Movement Therapy(CIMT) mode. The experimental group will receive RAGT in CIMT mode and BTX-A therapy. In the third year, BTX-A will be given to both control and experimental groups. In the control group, robotic training with full guidance force while the experimental group will receive robotic training with patient-cooperative robotic control training(PCRCT). In PCRCT the guidance force will be decreased according to patient’s active participation.

Project IDs

Project ID:PC10408-1273
External Project ID:MOST104-2314-B182-006-MY3
Effective start/end date01/08/1531/07/16


  • Stroke rehabilitation
  • Botulinum toxin A
  • Robotic-Assisted Training
  • motor control
  • Constraint-Induced


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