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

OBJECTIVE: To investigate the effect of combined botulinum toxin type A (BTX) and functional electric stimulation (FES) treatment on spastic drop foot in stroke.
DESIGN: Nonblinded randomized controlled trial.
SETTING: Hospitals.
PARTICIPANTS: Consecutive sample of 21 ambulant adults within 1 year after stroke with a spastic drop foot, of whom 18 completed the study.
INTERVENTIONS: The treatment group received BTX injections (Dysport) on 1 occasion into the medial and lateral heads of the gastrocnemius (200U each) and tibialis posterior (400U each) muscles and FES, used on a daily basis for 16 weeks to assist walking. Both groups continued with physiotherapy at the same rate.
MAIN OUTCOME MEASURES: Walking speed, Physiological Cost Index, Modified Ashworth Scale, Rivermead Motor Assessment, and Medical Outcomes Study 36-Item Short-Form Health Survey.
RESULTS: Walking speed increased over 12 weeks in both control (P=.020) and treatment groups (nonstimulated, P=.004 stimulated, P=.042). The baseline corrected (analysis of covariance) increase in mean walking speed at 12 weeks, relative to controls, was.04m/s (95% confidence interval [CI],.003-.090) without stimulation, and.09m/s (95% CI,.031-.150) with stimulation.
CONCLUSIONS: Combined treatment effectively improved walking and function. A larger study is needed to quantify the treatment effect and to investigate its impact on quality of life

adult, aged, article, assessment, botulinum toxin type a, care, cerebrovascular accident, combined modality therapy, electric stimulation therapy, female, gait disorders neurologic, health, hemiplegia, humans, male, middle aged, muscle spasticity, neuromuscular agents, outcome, outcomes, physiology, physiopathology, quality, quality of life, research support non-u.s.gov't, stroke, therapeutic use, therapy, treatment outcome, walking

10.1016/j.apmr.2003.08.081

0003-9993

902 - 909

Johnson, Catherine A.

7148454f-72a8-45fc-9d75-6b57402c20c3

Burridge, Jane H.

0110e9ea-0884-4982-a003-cb6307f38f64

Strike, Paul W.

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Wood, Duncan E.

03d805f5-6192-4fa0-846d-a42caa809231

Swain, Ian D.

d050385a-f6e3-4534-9c93-86ddd10924ef

June 2004

Johnson, Catherine A.

7148454f-72a8-45fc-9d75-6b57402c20c3

Burridge, Jane H.

0110e9ea-0884-4982-a003-cb6307f38f64

Strike, Paul W.

c128cb16-aa13-4237-8c2b-6803478b2805

Wood, Duncan E.

03d805f5-6192-4fa0-846d-a42caa809231

Swain, Ian D.

d050385a-f6e3-4534-9c93-86ddd10924ef

Johnson, Catherine A., Burridge, Jane H., Strike, Paul W., Wood, Duncan E. and Swain, Ian D. (2004) 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, 85 (6), 902 - 909. (doi:10.1016/j.apmr.2003.08.081).

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Published date: June 2004

Related URLs:

http://www.ncbi.nlm.nih.gov/en...s=15179643

Keywords: adult, aged, article, assessment, botulinum toxin type a, care, cerebrovascular accident, combined modality therapy, electric stimulation therapy, female, gait disorders neurologic, health, hemiplegia, humans, male, middle aged, muscle spasticity, neuromuscular agents, outcome, outcomes, physiology, physiopathology, quality, quality of life, research support non-u.s.gov't, stroke, therapeutic use, therapy, treatment outcome, walking