The use of combination therapy in the treatment of lower limb spasticity among patients after stroke - a review of literature

Stroke is not only a medical problem, but also, due to the permanent disability of patients, a significant social issue. Therefore, gait disturbances resulting from lower limb muscle spastici-ty are a common subject of research. The ambiguities in the scientific literature have become justification for the creation of this systematic review, the aim of which is to collect and ana-lyse works describing the efficacy of combination therapy - including Botulinum toxin type A injections and physiotherapy following stroke. The following databases were searched: Pub-Med, EBSCO, Springer Link (date of access: 24 Jan. 2019). It was assumed that analysis will include scientific works published in English from 2000 to date (in accordance with search date). For the entry "combination therapy" (Botulinum toxin injections and physiotherapy), the search was conducted using the following keywords: physical therapy, Botulinum toxin type A, Botox A, lower limb, gait, brain, stroke, hemiparesis. Out of all the elaborate articles, 7 concerning combination therapy were ultimately evaluated. Analysis of the collected works indicates the effectiveness of combination therapy in the area of improving structural parame-ters. Some of the works prove that this type of therapy also improves functional indices and leads to increased activity of patients. We could not collect satisfactory evidence confirming its effectiveness in terms of increasing social participation and improving the quality of life of patients. This review indicates the need to develop specific therapeutic protocols accurately describing both Botulinum toxin injections and physiotherapy - taking the intensity, duration and type of therapy into account. Opoka K., Filip M., Mirek E., Pasiut S. The use of combination therapy in the treatment of lower limb spasticity among patients after stroke − a review of literature. Med Rehabil 2019; 23(2): 36-41. DOI: 10.5604/01.3001.0013.0875 This article is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License CC BY-SA (http://creativecommons.org/licenses/by-sa/4.0/) null

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Long-term efficacy and tolerability of 4-monthly versus yearly botulinum toxin type A treatment for lower-limb spasticity in children with cerebral palsy

Developmental Medicine & Child Neurology ◽

10.1111/j.1469-8749.2008.03264.x ◽

2009 ◽

Vol 51 (6) ◽

pp. 436-445 ◽

Cited By ~ 22

Author(s):

PETR KAŇOVSKÝ ◽

MARTIN BAREŠ ◽

STANISLAV SEVERA ◽

ALAN RICHARDSON ◽

Keyword(s):

Cerebral Palsy ◽

Botulinum Toxin ◽

Lower Limb ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Children With Cerebral Palsy ◽

Limb Spasticity ◽

Lower Limb Spasticity

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Effect of botulinum toxin Type A on various gait parameters in cerebral palsy with lower limb spasticity

Journal of Medical Society ◽

10.4103/jms.jms_76_17 ◽

2018 ◽

Vol 32 (3) ◽

pp. 169

Author(s):

Abhimanyu Vasudeva ◽

Nonica Laisram ◽

AsemRangita Chanu

Keyword(s):

Cerebral Palsy ◽

Botulinum Toxin ◽

Lower Limb ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Gait Parameters ◽

Limb Spasticity ◽

Lower Limb Spasticity

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Botulinum Toxin Type A Improves Function According to Goal Attainment in Adults with Poststroke Lower Limb Spasticity in Real Life Practice

European Neurology ◽

10.1159/000503172 ◽

2019 ◽

Vol 82 (1-3) ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Lourdes López de Munain ◽

Josep Valls-Solé ◽

Irene Garcia Pascual ◽

Pascal Maisonobe ◽

Keyword(s):

Botulinum Toxin ◽

Lower Limb ◽

Goal Attainment ◽

Botulinum Toxin Type A ◽

Real Life ◽

Type A ◽

Botulinum Toxin Type ◽

Goal Achievement ◽

Limb Spasticity ◽

Lower Limb Spasticity

Introduction: Botulinum toxin type A (BoNT-A) is an effective and well-tolerated treatment for adult lower limb spasticity. However, data are inadequate to determine BoNT-A efficacy for active function. This study evaluated functional goal achievement (measured by goal attainment scaling [GAS]) following lower limb BoNT-A injection in clinical practice. Methods: Phase 4, postmarketing, multicenter, prospective, observational study (NCT01444794) in adults with poststroke lower limb spasticity receiving one BoNT-A injection cycle. Assessments were at baseline (pretreatment), 1 month ±7 days (visit 1), and 3–5 months posttreatment (visit 2). Primary outcome measure was GAS; additional assessments included Modified Ashworth Scale, Demeurisse Motricity Index, 10-meter walk test, and Disability Assessment Scale. Results: Of 100 enrolled patients, 94 completed the study. Most common primary treatment goals at baseline were improving mobility (57.5%) and positioning (18.1%). At visit 2, 88.3% achieved their primary goal; 87.0% (n = 47/54) for mobility, and 100.0% (n = 17/17) for positioning. In total, 79.1% of patients achieved their secondary goals. Two factors were predictive of primary goal achievement: time since stroke onset (OR 0.907; 95% CI 0.827–0.995; p = 0.038); and absence of stiff knee spasticity pattern (OR 0.228; 95% CI 0.057–0.911; p = 0.036). All functional scales showed improvements; walking speed (mean [SD]) improved by 0.06 (0.13) and 0.05 (0.20) m/s at visits 1 and 2, respectively. Conclusions: BoNT-A injection for lower limb spasticity led to high goal achievement rates in patient-centered GAS evaluation and functional and symptomatic improvements. BoNT-A may therefore deliver clinically meaningful functional improvements in real-life practice.

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