Raciti Loredana, Raciti Gianfranco, Ammendolia Antonio, de Sire Alessandro, Onesta Maria Pia, Calabrò Rocco Salvatore
Unità Spinale Unipolare, AO Cannizzaro, 98102 Catania, Italy.
Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy.
Brain Sci. 2024 Jun 24;14(7):631. doi: 10.3390/brainsci14070631.
Spasticity is a very common sign in the neurological field. It can be defined as "a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes" associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life". The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients' performance and outcomes. The combined strategies might rise the toxin's effect, lowering its dosages of botulinum and reducing side effects and costs.
痉挛是神经学领域非常常见的体征。它可被定义为“一种运动障碍，其特征为与张力亢进相关的、速度依赖性的肌张力增加或强直性牵张反射”。它会导致肢体畸形和疼痛的高风险，进而损害残余运动功能，影响生活质量。痉挛的治疗取决于其严重程度和部位，一般基于康复治疗、口服疗法（γ-氨基丁酸b激动剂巴氯芬）和注射药物（如作用于多突触反射机制的肉毒毒素）。A型肉毒毒素（BoNT-A）注射已被有效用于改善不同类型的痉挛。然而，当BoNT-A治疗效果不佳时，可以尝试非药物方法的联合使用。因此，可能需要额外的干预措施，如单独的传统物理治疗或进一步与机器人步态训练相结合。事实上，已有研究表明，BoNT-A与机器人技术相结合对中风患者（包括慢性期患者）的活动水平和上肢功能有积极影响。本综述的目的是评估与BoNT-A注射联合使用的药物或非药物治疗对痉挛的疗效。BoNT与传统或辅助活动或机器人辅助训练（特别是与末端执行器）的联合治疗是改善患者表现和治疗效果的有效工具。联合策略可能会增强毒素的效果，降低肉毒杆菌的剂量，减少副作用和成本。
