Botulinum Toxin Therapy Combined with Rehabilitation for Stroke: A Systematic Review of Effect on Motor Function

Hara, Takatoshi; Momosaki, Ryo; Niimi, Masachika; Yamada, Naoki; Hara, Hiroyoshi; Abo, Masahiro

doi:10.3390/toxins11120707

Cited by 35 publications

(26 citation statements)

References 51 publications

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“…Although it is possible that BoNT therapy could improve motor function and motor control, a recent meta-analysis further explained that the failure of function improvement after BoNT therapy is mainly due to muscle weakness [ 53 ]. In a selected group of stroke survivors, it is likely that BoNT therapy in combination with adjuvant therapy to strengthen spastic muscles may help improve motor function [ 54 ]. In this study, the same amount of BoNT was injected to biceps muscles with moderate-to-severe spasticity.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia

Chen

Zhang

Liu

et al. 2020

Toxins

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Spastic muscles are weak muscles. It is known that muscle weakness is linked to poor motor performance. Botulinum neurotoxin (BoNT) injections are considered as the first-line treatment for focal spasticity. The purpose of this study was to quantitatively investigate the effects of BoNT injections on force control of spastic biceps brachii muscles in stroke survivors. Ten stroke survivors with spastic hemiplegia (51.7 ± 11.5 yrs; 5 men) who received 100 units of incobotulinumtoxinA or onabotulinumtoxinA to the biceps brachii muscles participated in this study. Spasticity assessment (Modified Ashworth Scale (MAS) and reflex torque) and muscle strength of elbow flexors, as well as motor performance assessment (force variability of submaximal elbow flexion) were performed within one week before (pre-injection) and 3~4 weeks (3-wk) after BoNT injections. As expected, BoNT injections reduced the MAS score and reflex torque, and elbow flexor strength on the spastic paretic side. However, motor performance remained within similar level before and after injections. There was no change in muscle strength or motor performance on the contralateral arm after BoNT injections. The results of this study provide evidence that BoNT injections can reduce spasticity and muscle strength, while motor performance of the weakened spastic muscle remains unchanged.

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Section: Discussionmentioning

confidence: 99%

The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia

Chen

Zhang

Liu

et al. 2020

Toxins

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“…Untreated, spasticity may lead to long-term secondary complications such as soft tissue contractures, decreased activities of daily living, pain, pressure sores, social isolation which all lead to decreased quality of life [ 4 , 5 , 6 ]. Botulinum toxin type A (BoNT-A) has been found to be effective and safe for treating focal post-stroke spasticity in the rehabilitation setting [ 7 ]. Several randomized and non-randomized controlled studies have documented the effectiveness of BoNT-A injections in reducing muscle tone in both the upper and lower limb in post-stroke spasticity [ 8 , 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

BoNT-A for Post-Stroke Spasticity: Guidance on Unmet Clinical Needs from a Delphi Panel Approach

Baricich

Wein

Cinone

et al. 2021

Toxins

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There is extensive literature supporting the efficacy of botulinum toxin (BoNT-A) for the treatment of post-stroke spasticity, however, there remain gaps in the routine management of patients with post-stroke spasticity. A panel of 21 Italian experts was selected to participate in this web-based survey Delphi process to provide guidance that can support clinicians in the decision-making process. There was a broad consensus among physicians that BoNT-A intervention should be administered as soon as the spasticity interferes with the patients’ clinical condition. Patients monitoring is needed over time, a follow-up of 4–6 weeks is considered necessary. Furthermore, physicians agreed that treatment should be offered irrespective of the duration of the spasticity. The Delphi consensus also stressed the importance of patient-centered goals in order to satisfy the clinical needs of the patient regardless of time of onset or duration of spasticity. The findings arising from this Delphi process provide insights into the unmet needs in managing post-stroke spasticity from the clinician’s perspective and provides guidance for physicians for the utilization of BoNT-A for the treatment of post-stroke spasticity in daily practice.

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“…[ 18 ] However, it was also reported to limited evidence for improving active arm function, but improving basic upper extremity tasks (e.g., facilitation of dressing, hand hygiene) and pain. [ 9 – 10 ] Meanwhile, Rosales et al reported the same results that BoNTA injection combined rehabilitation can provide a sustained reduction in early poststroke upper extremity spasticity, but arm and hand function were not affected. [ 11 ] Shaw et al [ 10 ] argued that agonist active weakness may be the critical factor rather than restriction by the spasticity.…”

Section: Discussionmentioning

confidence: 98%

Wrist-hand extension function recovery in spastic hemiplegia patient by botulinum toxin injection plus surface electromyography biofeedback therapy

Wang²,

Zheng³

et al. 2021

Medicine

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Rationale: Wrist-hand extension function rehabilitation is a vital and difficult part of hand function recovery in spastic stroke patients. Although botulinum toxin type A (BoNTA) injection plus post injection therapy was applied to the wrist-hand rehabilitation in previous reports, conclusion was inconsistent in promoting function. For this phenomenon, proper selection of patients for BoNTA injection and correct choice of post-injection intervention could be the crucial factors for the function recovery. Patient concerns: We reported a 46-year-old male suffered a spastic hemiplegia with wrist- hand extension deficit. Diagnoses: Computed tomography showed cerebral hemorrhage in the left basal ganglia region. Interventions: Four hundred units of BoNTA were injected into the spasticity flexors, and four-week post injection surface electromyography (sEMG) biofeedback therapy was applied to the patient. Outcomes: The patient exhibited post-intervention improvement in wrist-hand extensors performance (strength, range of motion, sEMG signals), the flexors spasticity, and upper extremity function. Lessons: The present case showed that 4-week of BoNTA injection plus sEMG biofeedback exercise improved the performance and function of wrist-hand extensors in the patient for short- and long-term. Proper selection of patients for BoNTA injection and correct choice of post injection exercise could play a vital role in the hand rehabilitation for patient with spastic hemiplegia.

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Botulinum Toxin Therapy Combined with Rehabilitation for Stroke: A Systematic Review of Effect on Motor Function

Cited by 35 publications

References 51 publications

The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia

The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia

BoNT-A for Post-Stroke Spasticity: Guidance on Unmet Clinical Needs from a Delphi Panel Approach

Wrist-hand extension function recovery in spastic hemiplegia patient by botulinum toxin injection plus surface electromyography biofeedback therapy

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