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Integrated Rehabilitation Treatment of Focal Spasticity after Botulinum Toxin Type-A Injection

Raoul Saggini, Laura Scarcello, Alexandra Di Stefano, Simona Maria Carmignano, Giovanni Barassi, Christianpasquale Visciano, Roberto Antonacci, Vincenzo Scorrano and Rosa Grazia Bellomo

Several treatments have been proposed for the management of spasticity. The injection of botulinum toxin type A is considered the gold standard treatment and appears to be safe and effective. The combination between botulinum toxin type A (BTX-A) and physiotherapy (FKT) is thought to be able to enhance the effects. The aim of this study was to assess the effectiveness of the administration of botulinum toxin type A when combined with a specific rehabilitation protocol in subjects with focal spasticity. 44 subjects were randomly divided into two groups (A and B).

All subjects underwent ECO and EMG guided BTX-A injection. After the injection group A underwent a complex rehabilitation protocol with functional electrical stimulation, functional bandaging, manual therapy, cognitive sensory motor training and focal vibration on the treated muscle; group B made functional rehabilitation at home.

Both groups improved spasticity, pain and function in the first month after the inoculation (T1) but only in group A an improvement at the follow up performed in the subsequent 9 months was observed.

According to the results, it may be suggested that the inoculation of Botulinum toxin A should be properly placed within a specific rehabilitation program.