Physical and Pharmacological Combination Therapy Incorporating Botulinum Toxins

Dear Colleagues,

Botulinum toxin (BoNT) injection is widely used for the treatment of focal spasticity [1] to support physical rehabilitation or management interventions, which spasticity will often inhibit or prevent. BoNT is injected into the specific muscles where spasticity is identified [2]. However, the partial or complete delivery into muscles that are not the therapeutic target can result in the partial or complete absence of the intended therapeutic effect, and may lead to impaired activity in muscles that may be relied upon for function [1,3,4]. The method of localisation for injection is therefore one important element the outcome depends on.

In rehabilitation practice, we spend a significant amount of time and effort on planning interventions and treatment. The focus in spasticity management is the same as in any other area of rehabilitation, with a need to coordinate the physical and pharmacological aspects of management. Botulinum neurotoxins provide an opportunity to manage significant aspects of spasticity and facilitate further rehabilitation treatment or ongoing management. The use of botulinum toxin therefore often requires a combined treatment approach with physical rehabilitation programs forming a mainstay. In this Special Issue, we invite papers which showcase this interplay of the different aspects of treatment, which include treatment planning and coordination, treatment timing, outcome evaluation, and the specific targeting of muscle injection. The Special Issue will consider both patient-level reported outcomes and methods as well as clinical evaluation approaches. We welcome original research articles and reviews that contribute to advancing knowledge in this field.

Reference:

1. Royal College of Physicians; British Society of Rehabilitation Medicine; The Chartered Society of Physiotherapy; Association of Chartered Physiotherapists Interested in Neurology and the Royal College of Occupational Therapists. Spasticity in adults: management using botulinum toxin. National guidelines. Guideline Development Group: S Ashford (editor); L Turner-Stokes; R Allison, L Duke; P Moore; G Bavikatte; S Kirker, A Ward, D Bilton. London: Royal College of Physicians; 2018.
2. Zeuner KE, Knutzen A, Kühl C, Moller B, Hellriegel H, Margraf HG. Functional impact of different muscle localization techniques for Botulinum neurotoxin A injections in clinical routine management of post-stroke spasticity. Brain Injury. 2017;31(1):75-82.
3. Ashford S, Singer B, Rose H, Turner-Stokes L. The impact of spasticity and contractures on dependency and outcomes from rehabilitation. The Journal of the International Society of Physical and Rehabilitation Medicine. 2022;5(3):95-104.
4. Winston P, Branco Mills P, Reebye R, Vincent D. Cryoneurotomy as a Percutaneous Mini-invasive Therapy for the Treatment of the Spastic Limb: Case Presentation, Review of the Literature, and Proposed Approach for Use. . Archives of Rehabilitation Research and Clinical Translation. 2019;1:3-4.

Dr. Stephen Ashford
Guest Editor

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• botulinum neurotoxins
• physical therapies
• goal setting
• treatment planning
• outcome measurement