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Toxins 2019, 11(4), 210; https://doi.org/10.3390/toxins11040210

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

1
Spasticity and Movement Disorders “ReSTaRt” Unit, Physical Medicine and Rehabilitation Section, OORR Hospital, University of Foggia, 71122 Foggia, Italy
2
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
3
Physical Medicine and Rehabilitation Section, “OORR Hospital”, 71122 Foggia, Italy
*
Author to whom correspondence should be addressed.
Received: 11 March 2019 / Revised: 2 April 2019 / Accepted: 4 April 2019 / Published: 8 April 2019
(This article belongs to the Special Issue Botulinum Toxin: The Role in Neuro-Rehabilitation)
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PDF [279 KB, uploaded 8 April 2019]

Abstract

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 (n = 12; experimental group) or BoNT-A alone (n = 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. View Full-Text
Keywords: botulinum toxin A; isokinetic; poststroke; spasticity; BoNT-A; equinus foot botulinum toxin A; isokinetic; poststroke; spasticity; BoNT-A; equinus foot
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Cinone, N.; Letizia, S.; Santoro, L.; Facciorusso, S.; Armiento, R.; Picelli, A.; Ranieri, M.; Santamato, A. Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial. Toxins 2019, 11, 210.

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