Electrical stimulation of antagonist muscles after botulinum toxin type A for post-stroke spastic equinus foot. A randomized single-blind pilot study

Ann Phys Rehabil Med. 2019 Jul;62(4):214-219. doi: 10.1016/j.rehab.2019.06.002. Epub 2019 Jun 19.

Abstract

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 60min for 2 weeks (5 days/week). Assessments were performed before treatment (T0) and at 10 days (T1), 20 days (T2), and 90 days (T3) after treatment. Our primary outcome was gait velocity at a comfortable speed at T2 (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 T1, T2 and T3, both groups showed a significant reduction in muscle tone and an increase in ankle pROM (P<0.05). At T2 and T3, 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.

Keywords: Botulinum toxin type A; Electrical stimulation; Rehabilitation; Spasticity; Stroke.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Botulinum Toxins, Type A / therapeutic use*
  • Combined Modality Therapy
  • Electric Stimulation Therapy*
  • Equinus Deformity / drug therapy
  • Equinus Deformity / etiology
  • Equinus Deformity / therapy*
  • Female
  • Hemiplegia / drug therapy
  • Hemiplegia / etiology
  • Hemiplegia / therapy
  • Humans
  • Leg
  • Male
  • Middle Aged
  • Muscle Spasticity / drug therapy
  • Muscle Spasticity / etiology
  • Muscle Spasticity / therapy*
  • Neuromuscular Agents / therapeutic use*
  • Physical Endurance
  • Pilot Projects
  • Recovery of Function
  • Single-Blind Method
  • Stroke
  • Stroke Rehabilitation
  • Treatment Outcome

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A