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Adjuvant treatments associated with botulinum toxin injection for managing spasticity: An overview of the literature - 14/07/19

Doi : 10.1016/j.rehab.2018.08.004 
Alessandro Picelli a, b, , Andrea Santamato c, Elena Chemello a, Nicoletta Cinone c, Carlo Cisari d, Marialuisa Gandolfi a, b, Maurizio Ranieri c, Nicola Smania a, b, Alessio Baricich d
a Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy 
b Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy 
c Physical Medicine & Rehabilitation Section, ‘OORR’ Hospital, University of Foggia, Foggia, Italy 
d Health Sciences Department, Università del Piemonte Orientale, Novara, Italy 

Corresponding author. Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro, 10, 37134 Verona, Italy.Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaP.le L.A. Scuro, 10Verona37134Italy

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Abstract

Background and objective

A wide range of adjunct therapies after botulinum toxin administration have been proposed. The aim of the present paper is to provide an overview of major writings dealing with adjuvant (non-pharmacological) treatments associated with botulinum toxin for managing spasticity in order to provide some up-to-date information about the usefulness of the most commonly used procedures.

Methods

The literature in PubMed was searched with the MeSH terms botulinum toxins, muscle spasticity, physical therapy modalities, and rehabilitation. The results were limited to studies focusing on adjuvant treatments associated with botulinum toxin for managing spasticity. We excluded papers on the use of non-drug treatments for spasticity not associated with botulinum toxin serotype A (BoNT-A) injection. Relevant literature known to the authors along with this complementary search represented the basis for this overview of the literature.

Results

Adhesive taping and casting effectively improved the botulinum toxin effect in patients with upper- and lower-limb spasticity. There is level 1 evidence that casting is better than taping for outcomes including spasticity, range of motion and gait. However, consensus about their most appropriate timing, duration, target and material is lacking. In terms of physical modalities combined with botulinum toxin injection, we found level 1 evidence that extracorporeal shock wave therapy is better than electrical stimulation for some post-injection outcomes including spasticity and pain. Furthermore, electrical stimulation of injected muscles might be useful to boost the toxin effect. However, the best stimulation protocol has not been defined. In addition, we found level 2b evidence that whole-body vibration therapy might reduce spasticity with cerebral palsy.

Conclusion

Future research in this field should focus on investigating the most appropriate post-injection treatment protocol for each goal to achieve.

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Keywords : Botulinum toxins, Muscle spasticity, Physical therapy modalities, Rehabilitation


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Vol 62 - N° 4

P. 291-296 - juillet 2019 Retour au numéro
Article précédent Article précédent
  • Adjunct therapies to improve outcomes after botulinum toxin injection in children: A systematic review
  • L. Mathevon, I. Bonan, J.-L. Barnais, F. Boyer, M. Dinomais
| Article suivant Article suivant
  • Does acupuncture help patients with spasticity? A narrative review
  • Yi Zhu, Yujie Yang, Jianan Li

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