Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy; Physical Medicine and Rehabilitation, University Hospital "Maggiore della Carità", Novara, Italy.
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological, Biomedical and Movement Sciences, Università di Verona, Verona, Italy.
Ann Phys Rehabil Med. 2019 Jul;62(4):214-219. doi: 10.1016/j.rehab.2019.06.002. Epub 2019 Jun 19.
Botulinum toxin type A (BoNT-A) injection is an effective treatment for lower-limb spasticity and should be offered as first-line treatment for focal manifestations. Although its possible role has been hypothesized, the efficacy of electrical stimulation (ES) of antagonists of the injected muscles for improving clinical outcome after BoNT-A injection remains to be established.
This randomized single-blind pilot study aimed to investigate the efficacy of ES of antagonist muscles as adjunct treatment after BoNT-A injection to plantar flexor muscles in hemiplegic patients with spastic equinus foot.
After BoNT-A injection at triceps surae, patients were randomly allocated to 2 groups: group 1, single ES session on injected muscles plus 5 sessions of ES on antagonist muscles, and group 2, single ES session on injected muscles alone. Both groups underwent daily physical therapy for 60min for 2 weeks (5 days/week). Assessments were performed before treatment (T) and at 10 days (T), 20 days (T), and 90 days (T) after treatment. Our primary outcome was gait velocity at a comfortable speed at T (10-m walk test [10MWT]). The following were secondary outcomes: triceps surae spasticity (Modified Ashworth Scale), ankle passive range of motion (pROM), strength of tibialis anterior muscle, and 2-min walk test (2MWT).
The 30 patients enrolled were randomly allocated to the 2 groups: 15 in group 1 and 15 in group 2. At T, T and T, both groups showed a significant reduction in muscle tone and an increase in ankle pROM (P<0.05). At T and T, both groups showed a significant increase in 10MWT and 2MWT. The groups did not significantly differ in tibialis anterior strength or primary or secondary outcome measures.
ES of antagonist muscles does not improve clinical outcomes in the post-stroke spastic equinus foot after BoNT-A injection.
肉毒毒素 A 型（BoNT-A）注射是治疗下肢痉挛的有效方法，应作为局灶性表现的一线治疗方法。虽然已经假设了其可能的作用，但在 BoNT-A 注射后，对注射肌肉拮抗剂进行电刺激（ES）以改善临床结果的效果仍有待确定。
本随机单盲试点研究旨在探讨 BoNT-A 注射后对痉挛性马蹄内翻足偏瘫患者跖屈肌进行拮抗肌 ES 作为辅助治疗的疗效。
在比目鱼肌注射 BoNT-A 后，患者被随机分配到 2 组：组 1，注射肌肉单次 ES 加 5 次拮抗肌 ES；组 2，注射肌肉单次 ES。两组均接受每天 60 分钟的物理治疗，持续 2 周（每周 5 天）。在治疗前（T）和治疗后 10 天（T）、20 天（T）和 90 天（T）进行评估。我们的主要结局是 T 时舒适速度下的步态速度（10 米步行测试[10MWT]）。次要结局包括比目鱼肌痉挛（改良 Ashworth 量表）、踝关节被动活动度（pROM）、胫骨前肌力量和 2 分钟步行测试（2MWT）。
纳入的 30 例患者被随机分配到 2 组：组 1 15 例，组 2 15 例。在 T、T 和 T 时，两组肌肉张力均显著降低，踝关节 pROM 增加（P<0.05）。在 T 和 T 时，两组 10MWT 和 2MWT 均显著增加。两组间胫骨前肌力量或主要或次要结局指标均无显著差异。
在 BoNT-A 注射后，对卒中后痉挛性马蹄内翻足患者的拮抗肌进行 ES 并不能改善临床结果。
