Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy.
Physical Medicine & Rehabilitation Section, 'OORR' Hospital, University of Foggia, Foggia, Italy.
Ann Phys Rehabil Med. 2019 Jul;62(4):291-296. doi: 10.1016/j.rehab.2018.08.004. Epub 2018 Sep 13.
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.
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.
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.
Future research in this field should focus on investigating the most appropriate post-injection treatment protocol for each goal to achieve.
在肉毒毒素治疗后，已经提出了广泛的辅助治疗方法。本文旨在提供与肉毒毒素相关的辅助（非药物）治疗方法的主要文献综述，以提供有关最常用方法的最新信息。
使用 MeSH 术语肉毒毒素、肌肉痉挛、物理治疗方式和康复，在 PubMed 中搜索文献。结果仅限于专注于与肉毒毒素相关的辅助治疗以管理痉挛的研究。我们排除了与 BoNT-A 注射不相关的非药物治疗痉挛的文献。作者已知的相关文献以及该补充搜索为本文的文献综述提供了基础。
粘性贴扎和石膏固定可有效提高肉毒毒素在上肢和下肢痉挛患者中的疗效。有 1 级证据表明，对于包括痉挛、运动范围和步态在内的结果，石膏固定优于贴扎。然而，对于其最合适的时间、持续时间、目标和材料，仍缺乏共识。在与肉毒毒素注射相结合的物理治疗方法方面，我们发现有 1 级证据表明，体外冲击波治疗对于一些注射后结局，如痉挛和疼痛，优于电刺激。此外，注射肌肉的电刺激可能有助于增强毒素的效果。然而，最佳的刺激方案尚未确定。此外，我们发现有 2b 级证据表明全身振动疗法可能会降低脑瘫患者的痉挛。
未来在该领域的研究应重点研究针对每个目标的最合适的注射后治疗方案。
