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Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity

  1. Marina Demetrios1,*,
  2. Fary Khan1,
  3. Lynne Turner-Stokes2,
  4. Caroline Brand3,
  5. Shane McSweeney4

Editorial Group: Cochrane Stroke Group

Published Online: 5 JUN 2013

Assessed as up-to-date: 10 OCT 2012

DOI: 10.1002/14651858.CD009689.pub2


How to Cite

Demetrios M, Khan F, Turner-Stokes L, Brand C, McSweeney S. Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009689. DOI: 10.1002/14651858.CD009689.pub2.

Author Information

  1. 1

    Royal Melbourne Hospital, Royal Park Campus, Department of Rehabilitation Medicine, Melbourne, Victoria, Australia

  2. 2

    King's College London and Northwick Park Hospital, Regional Rehabilitation Unit, Harrow, Middlesex, UK

  3. 3

    Monash University, Centre of Research Excellence in Patient Safety (CREPS), Department of Epidemiology & Preventive Medicine, Melbourne, Victoria, Australia

  4. 4

    Guide Dogs Victoria, Melbourne, Victoria, Australia

*Marina Demetrios, Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Victoria, Australia. marina.demetrios@mh.org.au. mdemetrios@hotmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 5 JUN 2013

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Lai 2009 {published and unpublished data}
Sun 2010 {published and unpublished data}
  • Sun S, Hsu C, Sun H, Hwang C, Yang C, Wang J. Combined botulinum toxin type A with modified constraint induced movement therapy for chronic stroke patients with upper extremity spasticity: a randomized controlled study. Neurorehabilitation and Neural Repair 2010;24(1):34-41.
Weber 2010 {published and unpublished data}
  • Weber D, Skidmore E, Niyonkuru C, Chang C, Huber L, Munin M. Cyclic functional electrical stimulation does not enhance gains in hand grasp function when used as an adjunct to Onabotulinumtoxin A and task practice therapy: a single-blind, randomized controlled pilot study. Archives of Physical Medicine and Rehabilitation 2010;91:679-86.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Baricich 2008 {published data only}
  • Baricich A, Carda S, Bertoni M, Maderna L, Cisari C. A single-blinded, randomized pilot study of botulinum toxin type A combined with non-pharmacological treatment for spastic foot. Journal of Rehabilitation Medicine 2008;40(10):870-2.
Bayram 2006 {published data only}
  • Bayram S, Sivrioglu K, Karli N, Ozcan O. Low-dose botulinum toxin with short-term electrical stimulation in post-stroke spastic drop foot: a preliminary study. American Journal of Physical Medicine and Rehabilitation 2006;85(1):75-81.
Borg 2011 {published data only}
  • Borg J, Ward A, Wissel J, Kulkarni J, Sakel M, Ertzgaard P, et al. Rationale and design of a multicentre, double-blind, prospective, randomized, European and Canadian study: evaluating patient outcomes and costs of managing adults with post-stroke focal spasticity. Journal of Rehabilitation Medicine 2011;11(43):15-22.
Carda 2011 {published data only}
  • Carda S, Invernizzi M, Baricich A, Cisari C. Casting, taping or stretching after botulinum toxin type A for spastic equinus foot: a single-blind randomized trial on adult stroke patients. Clinical Rehabilitation 2011;25(12):1119-27.
Childers 2004 {published data only}
  • Childers M, Brashear A, Jozefczyk P, Reding M, Alexander D, Good D, et al. Dose-dependent response to intramuscular botulinum toxin type A for upper-limb spasticity in patients after a stroke. Archives of Physical Medicine and Rehabilitation 2004;85(7):1063-9.
Clark 2011 {published data only}
  • Clark PC, Aycock DM, Reiss A, Tanner D, Wolf SL. Treatment for stroke survivor upper extremity spasticity may benefit caregivers: a preliminary study. Stroke 2011;42(3):e61.
Clarke 2003 {published data only}
  • Clarke CE. A pragmatic randomised controlled trial of botulinum toxin and functional electrical stimulation in equinovarus spasticity. Current Controlled Trials (http://www.controlled-trials.com/) [ISRCTN 95945958] 2003.
Cui 2006 {published data only}
  • Cui LH. Domesitical botulinum toxin type A injection in the treatment of post-stroke patients with upper extremity spasticity. Chinese Journal of Neurology 2006;39(7):463-6.
Duarte 2011 {published data only}
  • Duarte E, Marco E, Cervantes C, Diaz D, Chiarella SC, Escalada F. Effects of botulinum toxin type A and electrostimulation on distal flexor spasticity of the upper limb in stroke. Randomized clinical trial. Rehabilitacion (Madrid) 2011;45(3):194-201.
Farina 2008 {published data only}
  • Farina S, Migliorini C, Gandolfi M, Bertolasi L, Casarotto M, Manganotti P, et al. Combined effects of botulinum toxin and casting treatments on lower limb spasticity after stroke. Functional Neurology 2008;23(2):87-91.
Guo 2006 {published data only}
  • Guo F. Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury. Neural Regeneration Research 2006;1(9):859-61.
Hesse 1995 {published data only}
  • Hesse S, Jahnke MT, Luecke D, Mauritz KH. Short-term electrical stimulation enhances the effectiveness of botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients. Neuroscience Letters 1995;201(1):37-40.
Hesse 1998 {published data only}
  • Hesse S, Reiter F, Konrad M, Jahnke MTl. Botulinum toxin type A and short-term electrical stimulation in the treatment of upper limb flexor spasticity after stroke: a randomized, double-blind, placebo-controlled trial. Clinical Rehabilitation 1998;12(5):381-8.
Johnson 2004 {published data only}
  • Johnson CA, Burridge JH, Strike PW, Wood DE, Swain ID. The effect of combined use of botulinum toxin type A and functional electric stimulation in the treatment of spastic drop foot after stroke: a preliminary investigation. Archives of Physical Medicine and Rehabilitation 2004;85(6):902-9.
Karadag-Saygi 2010 {published data only}
  • Karadag-Saygi E, Cubukcu-Aydoseli K, Kablan N, Ofluoglu D. The role of kinesiotaping combined with botulinum toxin to reduce plantar flexors spasticity after stroke. Topics in Stroke Rehabilitation 2010;17(4):318-22.
Kent 2006 {published data only}
  • Kent RM, Robertson AJ, Tennant A. Optimising botulinum toxin (BTX-A) treatment of upper limb spasticity in stroke using orthotics and physiotherapy: a randomized controlled trial. Neurorehabilitation and Neural Repair 2006;20(1):196.
Lagalla 1997 {published data only}
  • Lagalla G, Danni M, Reiter F, Cerevalo MG, Fiorani C, Severini S, et al. Enhancement of botox efficiency for upper limb spasticity using forearm splints. Journal of Neurologic Rehabilitation 1997; Vol. 11:138.
Marco 2007 {published data only}
  • Marco E, Duarte E, Vila J, Tejero M, Guillen A, Boza R, et al. Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial. Journal of Rehabilitation Medicine 2007;39(6):440-7.
Mawson 2007 {published data only}
  • Mawson S, Datta D, Clarke A, Harris I. Investigating the effects of botulinum toxin injections and physiotherapy on upper limb function for stroke patients: a randomised controlled trial. Physiotherapy 2007;93 Suppl 1:S564.
McCrory 2009 {published data only}
  • McCrory P, Turner-Stokes L, Baguley I, De Graaff S, Katrak P, Sandanam J, et al. Botulinum toxin A for treatment of upper limb spasticity following stroke: a multi-centre randomized placebo controlled study of the effects on quality of life and other person-centred outcomes. Journal of Rehabilitation Medicine 2009;41:536-44.
Meythaler 2009 {published data only}
  • Meythaler JM, Vogtle L, Brunner RC. A preliminary assessment of the benefits of the addition of botulinum toxin a to a conventional therapy program on the function of people with longstanding stroke. Archives of Physical Medicine and Rehabilitation 2009;90(9):1453-61.
Pieber 2011 {published data only}
  • Pieber K, Herceg M, Wick F, Grim-Stieger M, Bernert G, Paternostro-Sluga T. Functional electrical stimulation combined with botulinum toxin type A to improve hand function in children with spastic hemiparesis - a pilot study. Wiener Klinische Wochenschrift 2011;123(3-4):100-5.
Pisano 2002 {published data only}
  • Pisano F, Miscio G, Delconte C, Pianca D, Colombo R. Effects of short-term electrical stimulation in addition to botulinum toxin A treatment in the upper limb spasticity. Proceedings of the 3rd World Congress in Neurological Rehabilitation. Italy, Venice. 2-6 April 2002 (Abst T52).
Reiter 1998 {published data only}
  • Reiter F, Danni M, Lagalla G, Ceravolo G, Provinciali L. Low-dose botulinum toxin with ankle taping for the treatment of spastic equinovarus foot after stroke. Archives of Physical Medicine and Rehabilitation 1998;79(5):532-5.
Shaw 2011 {published data only}
  • Shaw, LC, Price CI, van Wijck FM, Shackley P, Steen N, Barnes MP, et al. Botulinum toxin for the upper limb after stroke (BoTULS) trial: effect on impairment, activity limitation, and pain. Stroke 2011;42(5):1371-9.
Sheikh 2006 {published data only}
  • Sheikh M, Olyaee GR, Abolfazli R, Hosseini HA. Assessment of the effects of neurodevelopmental treatment (NDT) and botulinum toxin injection on spastic hemiplegic patients. Journal of Iran University of Medical Sciences 2006;13(51):156.
Sisto 2001 {published data only}
  • Sisto SA, Bond Q, Chen B, Shiflett S, Elovic E, Johnston MV. Efficacy of acupressure versus botox in the treatment of spastic gait in stroke survivors. Journal of Stroke and Cerebrovascular Diseases 2001;10(4):198.
van Wijck 2006 {published and unpublished data}
  • van Wijck FMJ, Mackenzie J, Pandyan AD, Barnes MP, Johnson GR. Improving functional activity of the spastic upper limb in the chronic stage after stroke following botulinum toxin. Neurorehabilitation and Neural Repair 2006; Vol. 20, issue 1:173.
Werner 2011 {published data only}
  • Werner C, Mach H, Melzer I, Hesse S. Highly paretic patients within four to six weeks after stroke: an early botulinum toxin A treatment may prevent a disabling finger flexor spasticity six months later. Annals of Physical and Rehabilitation Medicine Conference 2011; Vol. 54 Suppl 1:e137.
Wolf 2007 {published data only}
  • Wolf S. Evaluation of BOTOX® with rehabilitation therapy for the treatment of wrist and hand spasticity in post-stroke patients (botox/rehab). Annals of Physical and Rehabilitation Medicine Conference 2011:e137.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Graham 2009 {published data only}
  • NCT00945295. Efficacy and safety study of botulinum neurotoxin A with rehabilitation versus botulinum neurotoxin A alone in treatment of post-stroke spasticity. ClinicalTrials.gov/show/NCT00945295 (accessed 18 January 2012).
Lannin 2011 {published data only}
  • Lannin N, Crotty M, Radcliffe J. The effectiveness of best practise therapy after Botulinum Toxin A injections for adults diagnosed with neurological impairment and onset of spasticity. Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au) ACTRN12612000091808 (accessed 12 February 2012).

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Ada 2006
  • Ada L, O'Dwyer N, O'Neill E. Relation between spasticity, weakness and contracture of the elbow flexors and upper limb activity after stroke: an observational study. Disability and Rehabilitation 2006;28(13-14):891-7.
Bakheit 2011
Barnes 2001
  • Barnes MP. Upper Motor Neurone Syndrome and Spasticity. Cambridge: Cambridge University Press, 2001.
Bhakta 1996
  • Bhakta B, Cozens J, Bamford J, Chamberlain MA. Use of botulinum toxin in stroke patients with severe upper limb spasticity. Journal of Neurology, Neurosurgery, and Psychiatry 1996;61:30–5.
Bhakta 2000
  • Bhakta BB, Cozens JA, Chamberlain MA, Bamford JM. Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. Journal of Neurology, Neurosurgery, and Psychiatry 2000;69:217-21.
Bohannon 1987
Brashear 2002
  • Brashear A, Gordon M, Elovic E, Kassicieh D, Marciniak C, Lee C, et al. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after stroke. New England Journal of Medicine 2002;347(6):395–400.
De Jong 2004
  • DeJong G, Horn S, Gassaway J, Slavin M, Dijkers M. Toward a taxonomy of rehabilitation interventions: using an inductive approach to examine the 'Black Box' of rehabilitation. Archives of Physical Medicine and Rehabilitation 2004;85:678-86.
De Paiva 1999
  • De Paiva A, Meuniere FA, Molgo J, Aoki KR, Dolly JO. Functional repair of motor endplates after botulinum neurotoxin type A poisoning: biphasic switch of synaptic activity between nerve sprouts and their parent terminals. Proceedings of the National Academy of Sciences of the United States of America 1999;96:3200-5.
Elia 2009
Esquenazi 2001
  • Esquenazi A, Mayer N. Botulinum toxin for the management of muscle overactivity and spasticity after stroke. Current Atherosclerosis Reports 2001;3:295–8.
Esquenazi 2010
Esquenazi 2011
  • Esquenazi A. The human and economic burden of poststroke spasticity and muscle overactivity. Journal of Clinical Outcomes Management 2011;18(1):607-14.
Francis 2004
  • Francis HP, Wade DT, Turner-Stokes L, Kingswell RS, Dott CS, Coxon EA. Does reducing spasticity translate into functional benefit? An exploratory meta-analysis. Journal of Neurology, Neurosurgery, and Psychiatry 2004;75:1547–51.
Gassaway 2005
  • Gassaway J, Horn SD, DeJong G, Smout RJ, Clark C, James R. Applying the clinical practice improvement approach to stroke rehabilitation: methods used and baseline results. Archives of Physical Medicine and Rehabilitation 2005;86 Suppl 2:S16-33.
Gowland 1993
Gracies 2001
  • Gracies JM. Pathophysiology of impairment in patients with spasticity and use of stretch as a treatment of spastic hypertonia. Physical Medicine and Rehabilitation Clinics of North America 2001;12:747-68.
Green 2002
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Khan 2007
  • Khan F, Turner-Stokes L, Ng L, Kilpatrick T, Amatya B. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD006036.pub2]
Kiresuk 1968
Lance 1980
  • Lance JW. Spasticity: disordered motor control. In: Feldman RG, Young RR, Koella WP editor(s). Symposium Synopsis. Chicago: Year Book Medical Publishers, 1980:485-94.
Langhorne 2011
Levy 2007
  • Levy CE, Giuffrida C, Richards L, Wu S, Davis S, Nadeau SE. Botulinum Toxin A, evidence-based exercise therapy, and constraint-induced movement therapy for upper-limb hemiparesis attributable to stroke a preliminary study. American Journal of Physical Medicine and Rehabilitation 2007;86:696–706.
Lundstrom 2010
  • Lundstrom E, Smits A, Borg J, Terent A. Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event. Stroke 2010;41(2):319–24.
Lyle 1981
Lyons 2008
  • Lyons BE, Moore P, Bhakta BB, Bamford JM, Cardwell C, Logan ID. Botulinum toxin for adult spasticity after stroke or non-progressive brain lesion. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD002926.pub2]
Mackay 2004
  • Mackay J, Mensah G, World Health Organization (WHO). The atlas of heart disease and stroke. http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdf 2004:50.
Malhotra 2009
Mehrholz 2005
  • Mehrholz J, Wagner K, Meissner D, Grundmann K, Zange C, Koch R, et al. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clinical Rehabilitation 2005;19(7):751–9.
Monaghan 2011
  • Monaghan K, Horgan F, Blake C, Cornall C, Hickey PPM, Lyons BE, et al. Physical treatment interventions for managing spasticity after stroke. Cochrane Database of Systematic Reviews 2011, Issue 7. [DOI: 10.1002/14651858.CD009188]
Murphy 2000
  • Murphy B, Herman H, Hawthorne G, Pinzone T, Evert H. Australian WHOQoL instruments: user's manual and interpretation guide. Australian WHOQoL Field Study Centre, Melbourne, Australia 2000.
Olver 2010
Pandyan 2005
  • Pandyan AD, Gregoric M, Barnes MP, Wood D, van Wijck F, Burridge J, et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disability and Rehabilitation 2005;27(1/2):2-6.
Peurala 2011
  • Peurala SH, Kantanen MP, Sjogren T, Paltamaa J, Maarit Karhula M, Heinonen A. Effectiveness of constraint-induced movement therapy on activity and participation after stroke: a systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation 2011;26(3):209-23.
Podsiadlo 1991
RevMan 2011 [Computer program]
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Robinson 1983
Rousseaux 2002
Sheean 1998
  • Sheean G. Pathophysiology of spasticity. In: Sheean G editor(s). Spasticity Rehabilitation. 1st Edition. London: Churchill Communications Europe Ltd, 1998:17-38.
Sheean 2001
Sheean 2010
Slawek 2005
  • Slawek J, Bogucki A, Reclawowicz D. Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens. Neurological Sciences 2005;26:32-9.
Stevenson 2010
Stiens 2002
  • Stiens S, O'Young B, Young M. Person-centred rehabilitation: interdisciplinary intervention to enhance patient enablement. In: O'Young B, Young M, Stiens S editor(s). Physical Medicine and Rehabilitation Secrets. 2nd Edition. USA: Hanley & Belfus, 2002:4-9.
Tennant 2007
Turner-Stokes 2005
Turner-Stokes 2009
  • Turner-Stokes L, Ward AB. Spasticity in Adults: Management using Botulinum Toxin. National Guidelines. London: Royal College of Physicians, 2009.
Turner-Stokes 2010a
  • Turner-Stokes L, Ashford S, Williams H. Poster 435: A UK pilot for a large international prospective cohort analysis of the use of Botulinum Toxin A (BoNT-A) in upper limb spasticity (abstract). Physical Medicine and Rehabilitation 2010;2 Suppl 9:S190–1.
Turner-Stokes 2010b
  • Turner-Stokes L, Ashford S, Nair A. Poster 19: Psychometric evaluation of the Arm Activity Measure (ArmA) – a measure of active and passive function in the hemiparetic arm. Physical Medicine and Rehabilitation 2010;2 Suppl 9:S13–4.
Turner-Stokes 2010c
  • Turner-Stokes L, Baguley I, De Graaff S, Katrak P, Davies L, McCrory P, et al. Goal attainment scaling in the evaluation of treatment of upper limb spasticity with botulinum toxin: a secondary analysis from a double-blind placebo-controlled randomized clinical trial. Journal of Rehabilitation Medicine 2010;42:81-9.
Van der Lee 2004
Wade 2010
Watkins 2002
WHO 1989
WHO 2001
  • World Health Organization (WHO). International Classification of Functioning Disability and Health (ICF). WHO Geneva 2001.
WHO 2003
  • WHO. The World Health Report 2003: Shaping the Future. http://www.who.int/whr/2003/en/whr03_en.pdf (accessed 2 September 2011) October 2003.
Wolf 2006
  • Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke. The EXCITE randomized clinical trial. JAMA 2006;296(17):2095-104.