Abstract
Several treatments have been proposed for the management of spasticity. The injection of botulinum toxin type A is considered the gold standard treatment and appears to be safe and effective. The combination between botulinum toxin type A (BTX-A) and physiotherapy (FKT) is thought to be able to enhance the effects. The aim of this study was to assess the effectiveness of the administration of botulinum toxin type A when combined with a specific rehabilitation protocol in subjects with focal spasticity. 44 subjects were randomly divided into two groups (A and B). All subjects underwent ECO and EMG guided BTX-A injection. After the injection group A underwent a complex rehabilitation protocol with functional electrical stimulation, functional bandaging, manual therapy, cognitive sensory motor training and focal vibration on the treated muscle; group B made functional rehabilitation at home. Both groups improved spasticity, pain and function in the first month after the inoculation (T1) but only in group A an improvement at the follow up performed in the subsequent 9 months was observed. According to the results, it may be suggested that the inoculation of Botulinum toxin A should be properly placed within a specific rehabilitation program.
Highlights
In Italy, the number of subjects affected by a stroke who survived, with disabling outcomes, is about 913,000 people
Average value of spasticity measured by the Ashworth scale amounted to 2.2 for the shoulder, to 2.6 for the elbow, to 2.4 for the wrist
Average score MRC was equal to 1.6 on the muscles treated; the average value of subjective pain was equal to 3.6 Visual Analog Scale for Pain (VAS)
Summary
In Italy, the number of subjects affected by a stroke who survived, with disabling outcomes, is about 913,000 people. The development of focal spasticity is one of the problems that can further limit the functional recovery and may weigh heavily on the disability of the affected patients. For the first time in 1980, Lance defined spasticity as a complex hyperkinetic syndrome characterized by an increase of the stretch reflex and a loss of motor control, consequence of the neuronal reorganization as a result of the damage or injury. It becomes clinically evident with increasing speed-dependent resistance to passive movement of a joint [2,3]. The SPASM group [4,5] elaborated a wider definition of spasticity describing it as a motor sensor disorder
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