Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, OORR Hospital, University of Foggia, 71122 Foggia, Italy.
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy.
Toxins (Basel). 2019 Apr 8;11(4):210. doi: 10.3390/toxins11040210.
Botulinum toxin A (BoNT-A) has been shown effective for poststroke lower limb spasticity. Following injections, a wide range of multidisciplinary approach has been previously provided. The purpose of this pilot, single-blind, randomized controlled trial was to determine whether BoNT-A combined with a regime of a four-week ankle isokinetic treatment has a positive effect on function and spasticity, compared with BoNT-A alone. Secondly, the validity of the use of an isokinetic dynamometer to measure the stretch reflex at the ankle joint and residual strength has been investigated. Twenty-five chronic stroke patients were randomized to receive combined treatment ( = 12; experimental group) or BoNT-A alone ( = 13; control group). Outcome measures were based on the International Classification of Functioning, Disability and Health. An isokinetic dynamometer was also used for stretch reflex and strength assessment. Patients were evaluated at baseline (t0), after five (t1) and eight weeks after the injection (t2). The experimental group reported significantly greater improvements on lower limb spasticity, especially after eight weeks from baseline. Gait speed (10-m walk test) and walking capacity (6-min walking test) revealed statistically significantly better improvement in the experimental than in control group. Peak resistive ankle torque during growing angular velocities showed a significant reduction at the higher velocities after BoNT-A injections in the experimental group. Peak dorsiflexor torque was significantly increased in the experimental group and peak plantarflexor torque was significantly decreased in control group. Alternative rehabilitation strategies that combine BoNT-A and an intense ankle isokinetic treatment are effective in reducing tone and improving residual strength and motor function in patients with chronic hemiparesis.
肉毒杆菌毒素 A（BoNT-A）已被证明可有效治疗脑卒中后下肢痉挛。在注射后，之前已经提供了多种多学科的综合治疗方法。本试验旨在确定 BoNT-A 联合为期四周的踝关节等速治疗方案是否比单独使用 BoNT-A 更能有效改善功能和痉挛，这是一项单盲、随机对照试验。其次，还研究了使用等速测力计测量踝关节伸展反射和残余肌力的有效性。25 名慢性脑卒中患者被随机分为联合治疗组（n = 12；实验组）或 BoNT-A 单独治疗组（n = 13；对照组）。疗效评估基于国际功能、残疾和健康分类。等速测力计也用于测量伸展反射和肌力。患者在基线（t0）、注射后 5 周（t1）和 8 周（t2）进行评估。实验组在下肢痉挛方面的改善明显优于对照组，特别是在基线后 8 周。10 米步行试验的步态速度和 6 分钟步行试验的步行能力显示，实验组的改善明显优于对照组。在实验组，BoNT-A 注射后在较高角速度下的抗阻踝关节峰值扭矩显著降低，而实验组的背屈峰值扭矩显著增加，对照组的跖屈峰值扭矩显著降低。将 BoNT-A 与强烈的踝关节等速治疗相结合的替代康复策略，可有效降低肌张力，改善慢性偏瘫患者的残余肌力和运动功能。
