How Botulinum Toxin Type A- Occupational Therapy (OT)-Functional Electrical Stimulation (FES) Modify Spasticity and Functional Recovery in Patients with Upper Limb Spasticity Post Stroke

Abstract

Introduction: Spasticity is the most important problem in the recovery of a satisfactory function of the upper limb to the patient outcomes of cerebral stroke. Objective of the study is to compare the results in functional recovery in patients treated with botulinum toxin A and occupational therapy and patients treated with botulinumtoxinA, occupational therapy (OT) and functional electrical stimulation (FES) (Ness H-200).Materials and methods: 36 patients (middle aged 55,25±6,5) with spasticity of the upper limbs for more than six months and in particular with the involvement of the muscles of the hand. Patients were divided into two groups: Group I underwent botulinumtoxinA-occupational therapy-functional electrical stimulation, Group II underwent botuli-numtoxinA and occupational therapy. All patients were evaluated with the modified Ashworth scale, with the measurement of the passive ROM, the evaluation of the amplitude of the compound action potential of the median nerve (registration site in the flexor digitorum superficial) and ARAT test at the time T0 (recruitment and infiltration), T1 (20 days after first infiltration), T2 (3 months after first infiltration), T3 (four months after first infiltration; we reinjected botulinumtoxinA), T4 (20 days after second infiltration), T5 (3 months after second infiltration), T6 ( four months after first infiltration; we reinjected botulinum toxin A).Result: Group treated with botulinumtoxinA-OT-FES showed a statistically significant improvement compared to the other group in the evaluation of the passive ROM, in the assessment of spasticity with the modified Ashworth scale, in the reduction of the amplitude cMAP of the median nerve and in the score of ARAT test. Conclusions:The application of the FES joined to treatment with botulinumtoxinA and OT proves effective synergy for greater functional recovery of the upper limb and the best possible outcomes.

“Appropriate Treatment” and Therapeutic Window in Spasticity Treatment with IncobotulinumtoxinA: From 100 to 1000 Units

“…In fact, during any pharmacological and/or physiokinesis and/or instrumental spasticity treatment, we studied therapeutic efficacy and we monitored the desired clinical effects without any alterations either in the omolateral antagonist muscles or in the contralateral agonists and antagonist muscles [ 20 ]. For example, wrist and finger control is very compromised after stroke; evaluating properties of the muscles responsible for these functions can help the physiatrist to realize the severity of the disability that the patient is encountering [ 21 ]. Instead, evaluation of triceps muscle tone may provide useful indications of load and balance alterations while standing and walking, with consequent repercussions on the entire musculoskeletal system [ 22 , 23 ].…”

The Effectiveness of Botulinum Toxin Injections to Treat Post-Stroke Arm Dysfunction

“…An RCT that examined the combined use of BoNT with functional electrical stimulation found improved spasticity, passive range of motion, and motor function compared to BoNT with conventional therapy. 32 This may indicate that electrical stimulation is another effective combination of treatments when used with BoNT. However, more research is needed to validate these findings.…”

“…However, there is some evidence indicating that BoNT can be used safely and effectively in the early stages of stroke. Six RCTs examined the effect of BoNT in chronic stroke, 19,[24][25][26][27]32 while four enrolled patients in the acute or subacute stages. 23,28,29,31 All four RCTs that examined acute and subacute patients found a significant decrease in spasticity but no improvement in motor function.…”