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Electrical stimulation of antagonist muscles after botulinum toxin type A for post-stroke spastic equinus foot. A randomized single-blind pilot study - 20/06/19

Doi : 10.1016/j.rehab.2019.06.002 
Alessio Baricich, MD, PhD 1, 2, , Alessandro Picelli 3, Stefano Carda 4, Nicola Smania 3, Carlo Cisari 1, 2, Andrea Santamato 5, Alessandro de Sire 1, 6, Marco Invernizzi 1
1 Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy 
2 Physical Medicine and Rehabilitation, University Hospital “Maggiore della Carità”, Novara, Italy 
3 Neuromotor and Cognitive Rehabilitation Research Center. Department of Neurological, Biomedical and Movement Sciences, Università di Verona, Verona, Italy 
4 Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience. Lausanne University Hospital (CHUV), Lausanne, Switzerland 
5 Department of Physical Medicine and Rehabilitation, “OORR Hospital”, Università di Foggia, Foggia, Italy 
6 Rehabilitation Unit, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy 

Corresponding author: Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, Viale Piazza d’armi 1, 28100, Novara, ItalyPhysical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, Viale Piazza d’armi 1Novara28100Italy
Sous presse. Manuscrit accepté. Disponible en ligne depuis le jeudi 20 juin 2019
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Highlights

Botulinum toxin type A (BoNT-A) injection is an effective treatment for lower-limb spasticity.

A wide range of adjunct therapies has been proposed to improve the BoNT-A effect, but the role of electrical stimulation (ES) of antagonist muscles is still unclear.

Our results do not support the use of ES of antagonist muscles after BoNT-A injection to plantar flexors muscles for post-stroke spasticity.

ES should probably be applied to injected muscles only, to boost the BoNT-A effect.

Le texte complet de cet article est disponible en PDF.

Abstract

Background. Botulinum toxin type A (BoNT-A) injection is an effective treatment for lower-limb spasticity and should be offered as first-line treatment for focal manifestations. Although its possible role has been hypothesized, the efficacy of electrical stimulation (ES) of antagonists of the injected muscles for improving clinical outcome after BoNT-A injection remains to be established.

Objectives. This randomized single-blind pilot study aimed to investigate the efficacy of ES of antagonist muscles as adjunct treatment after BoNT-A injection to plantar flexor muscles in hemiplegic patients with spastic equinus foot.

Methods. After BoNT-A injection at triceps surae, patients were randomly allocated to 2 groups: group 1, single ES session on injected muscles plus 5 sessions of ES on antagonist muscles, and group 2, single ES session on injected muscles alone. Both groups underwent daily physical therapy for 60 min for 2 weeks (5 days/week). Assessments were performed before treatment (T0) and at 10 days (T1), 20 days (T2), and 90 days (T3) after treatment. Our primary outcome was gait velocity at a comfortable speed at T2 (10-m walk test [10MWT]). The following were secondary outcomes: triceps surae spasticity (Modified Ashworth Scale), ankle passive range of motion (pROM), strength of tibialis anterior muscle, and 2-min walk test (2MWT).

Results. The 30 patients enrolled were randomly allocated to the 2 groups: 15 in group 1 and 15 in group 2. At T1, T2 and T3, both groups showed a significant reduction in muscle tone and an increase in ankle pROM (p<0.05). At T2 and T3, both groups showed a significant increase in 10MWT and 2MWT. The groups did not significantly differ in tibialis anterior strength or primary or secondary outcome measures.

Conclusions. ES of antagonist muscles does not improve clinical outcomes in the post-stroke spastic equinus foot after BoNT-A injection.

Le texte complet de cet article est disponible en PDF.

Keywords : stroke, spasticity, botulinum toxin type A, electrical stimulation, rehabilitation



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