Journal
ANNALS OF PHYSICAL AND REHABILITATION MEDICINE
Volume 62, Issue 4, Pages 214-219Publisher
ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER
DOI: 10.1016/j.rehab.2019.06.002
Keywords
Stroke; Spasticity; Botulinum toxin type A; Electrical stimulation; Rehabilitation
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Background: 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. Objectives: 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. Methods: 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 60 min for 2 weeks (5 days/week). Assessments were performed before treatment (T-0) and at 10 days (T-1), 20 days (T-2), and 90 days (T-3) after treatment. Our primary outcome was gait velocity at a comfortable speed at T-2 (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). Results: The 30 patients enrolled were randomly allocated to the 2 groups: 15 in group 1 and 15 in group 2. At T-1, T-2 and T-3, both groups showed a significant reduction in muscle tone and an increase in ankle pROM (P < 0.05). At T-2 and T-3, 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. Conclusions: ES of antagonist muscles does not improve clinical outcomes in the post-stroke spastic equinus foot after BoNT-A injection. (C) 2019 Elsevier Masson SAS. All rights reserved.
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