• botulinum toxins type A
• lower limb
• muscle spasticity
• rehabilitation
• spastic gait
• stroke

• Adult
• Aged
• Female
• Humans
• Male
• Middle Aged
• Botulinum Toxins, Type A/administration & dosage
• Dose-Response Relationship, Drug
• Gait Disorders, Neurologic/drug therapy
• Gait Disorders, Neurologic/etiology
• Lower Extremity/physiopathology
• Muscle Spasticity/drug therapy
• Muscle Spasticity/etiology
• Neuromuscular Agents/administration & dosage
• Outcome Assessment, Health Care
• Prospective Studies
• Stroke/complications
• Stroke/drug therapy
• Treatment Outcome

• HEALTH ECONOMICS
• Rehabilitation medicine
• Stroke medicine

• Humans
• Botulinum Toxins, Type A/economics
• Botulinum Toxins, Type A/therapeutic use
• Muscle Spasticity/drug therapy
• Muscle Spasticity/etiology
• Muscle Spasticity/economics
• Thailand
• Cost-Benefit Analysis
• Stroke/complications
• Stroke/economics
• Quality-Adjusted Life Years
• Middle Aged
• Male
• Female
• Neuromuscular Agents/therapeutic use
• Neuromuscular Agents/economics
• Markov Chains
• Retrospective Studies
• Upper Extremity

• Ministry of Public Health

• AbobotulinumtoxinA
• Botulinum toxin A
• Goal attainment scaling
• Lower limb spasticity
• rehabilitation

• Botulinum toxin
• Distonia
• Dystonia
• Espasticidad
• Spasticity
• Toxina botulínica

• Humans
• Botulinum Toxins, Type A/therapeutic use
• Botulinum Toxins, Type A/administration & dosage
• Muscle Spasticity/drug therapy
• Torticollis/drug therapy
• Neuromuscular Agents/therapeutic use
• Neuromuscular Agents/administration & dosage
• Muscle, Skeletal/drug effects
• Muscle, Skeletal/pathology
• Cadaver
• Injections, Intramuscular

• BoNT-A
• bibliometric analysis
• neurological disorders
• research trends
• spasticity

• Muscle Spasticity/drug therapy
• Bibliometrics
• Humans
• Botulinum Toxins, Type A/therapeutic use
• Neuromuscular Agents/therapeutic use

• AbobotulinumtoxinA
• cerebral palsy
• children
• clinical characteristics/tell-tale signs of pain
• pain
• parental perception of pain
• spasticity

• Humans
• Child
• Neuromuscular Agents/therapeutic use
• Cerebral Palsy/drug therapy
• Quality of Life
• Treatment Outcome
• Botulinum Toxins, Type A/therapeutic use
• Muscle Spasticity/drug therapy
• Pain/drug therapy
• Arthralgia/drug therapy

• Botulinum neurotoxin
• Botulinum toxin
• Dystonia
• Motor system
• Spasticity
• Tremor

• Humans
• Botulinum Toxins/therapeutic use
• Motor Disorders
• Dystonia/drug therapy
• Dystonic Disorders
• Movement Disorders/drug therapy

• acupuncture
• foot drop in post-stroke
• protocol
• systematic review

• Humans
• Acupuncture Therapy/adverse effects
• Acupuncture Therapy/methods
• Meta-Analysis as Topic
• Peroneal Neuropathies/etiology
• Peroneal Neuropathies/therapy
• Quality of Life
• Randomized Controlled Trials as Topic
• Research Design
• Stroke/complications
• Stroke/therapy
• Systematic Reviews as Topic/methods
• Systematic Reviews as Topic/standards
• Data Analysis

• clubfoot
• muscle spasticity
• achilles tendon
• muscle contraction

• Botulinum toxin
• Gait
• Hemiplegia
• MAS
• Stroke

• Botulinum toxin
• Gait analysis
• Spasticity
• Stroke

• Paresis
• contracture
• spasticity
• stroke
• walking

• aboBoNT/A
• active range of movement
• functional benefit
• gait velocity
• motor learning
• spastic foot drop

• Adult
• Botulinum Toxins, Type A/therapeutic use
• Humans
• Injections, Intramuscular
• Muscle Spasticity/drug therapy
• Neuromuscular Agents/therapeutic use
• Peroneal Neuropathies
• Range of Motion, Articular
• Stroke Rehabilitation
• Walking

Post-stroke spasticity impedes patients’ rehabilitation progress. Contradictory evidence has been reported in using Botulinum Neurotoxin type A (BoNT-A) to manage post-stroke lower extremity spasticity (PLES); furthermore, an optimum dose of BoNT-A for PLES has not yet been established. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to identify the efficacy and optimal dose of BoNT-A on PLES. "Meta" and "Metafor" packages in R were used to analyze the data. Hedges’ g statistic and random effect model were used to calculate and pool effect sizes. Twelve RCTs met the eligibility criteria. Muscle tone significantly improved in week four, week eight, and maintained to week twelve after BoNT-A injection. Improvements in functional outcomes were found, some inconsistencies among included studies were noticed. Dosage analysis from eight studies using Botox® and three studies using Dysport® indicated that the optimum dose for the commonest pattern of PLES (spastic plantar flexors) is medium-dose (approximately 300U Botox® or 1000 U Dysport®). BoNT-A should be regarded as part of a rehabilitation program for PLES. Furthermore, an optimal rehabilitation program combined with BoNT-A management needs to be established. Further studies should also focus on functional improvement by BoNT-A management in the early stage of stroke.

• Botulinum toxin
• lower extremity
• optimal dose
• spasticity
• stroke

Outcome differences between selective abobotulinumtoxin type A (aboBoNT/A) injections into the soleus (SOL) and gastrocnemius (GAS) muscles were investigated in post-stroke patients with spastic foot drop.

A monocentric observational study was conducted at a university hospital botulinum toxin clinic including 24 free-walking adult, botulinum toxin-naive patients with post-stroke hemiplegia. AboBoNT/A (800 MU in 4 mL saline) was injected into the SOL or GAS muscle under electromyographic guidance. After 30 days post-injection, the effect of aboBoNT/A injection was assessed by patients. The treating physician scored spasticity and measured angles at the knee and ankle joint and gait speed.

After 30 days, significant improvements of subjective and objective outcome measures were observed. No significant difference was observed in the modified Ashworth scale, gait speed, ankle and knee angles, or their angle combinations between the SOL and GAS groups. Tendencies toward greater active range of motion (RoM) improvement in the SOL group and passive RoM improvement in the GAS group were observed. The difference between active and passive ankle extensions plus knee flexions was significantly larger in the SOL group.

Selective 800 MU aboBoNT/A injections into the SOL or GAS muscle were effective but without relevant clinical difference.

• Spastic foot drop
• abobotulinumtoxin type A
• active and passive range of motion
• gastrocnemius muscle
• muscle fiber decomposition
• soleus muscle

The objectives of this study were to evaluate whether botulinum toxin type A (BoNT-A) treatment for lower limb spasticity leads to patient goal attainment and identify factors associated with positive goal attainment and to assess the effect of BoNT-A treatment on patients’ gait.

Retrospective cohort study between June 2014 and February 2019.

Public outpatient spasticity clinic in a tertiary hospital.

Thirty patients (N=30; 50% female; average age, 50.5y) with lower limb spasticity of heterogenous etiologies (96.7% cerebral±spinal origin and 3.3% isolated spinal origin); 73.3% (N=22) of patients had previously received BoNT-A treatment.

BoNT-A injection to lower limb muscles.

The primary outcome measure was goal attainment measured using Goal Attainment Scaling. The Modified Ashworth Scale (MAS) was used to assess spasticity. Gait was characterized by spatiotemporal parameters.

Fifty-six treatment episodes were analyzed and showed that BoNT-A treatment resulted in a significant reduction in spasticity (pretreatment MAS=3.18±0.73; posttreatment MAS=2.27±0.89; P<.001) with no associated change in gait parameters. Logistic regression revealed that most patients (74.1%) achieved all of their goals, with younger patients having a high likelihood of goal attainment regardless of their gait profile identified by latent profile analysis of the gait parameters. Patients considered to have a low functioning gait profile demonstrated a significantly greater likelihood of goal attainment than patients with the other gait profiles combined (odds ratio, 45.6; 95% confidence interval, 1.3-1602.1; P=.036). Chronic spasticity and pretreatment severity of spasticity (MAS) and its reduction were not associated with likelihood of goal attainment.

The success and efficacy of BoNT-A treatment in improving patient perceived gait quality and reducing the negative symptoms of spasticity were best measured using Goal Attainment Scaling. The study emphasizes the importance of measuring patient goals as a clinical outcome. Gait parameters were most informative when used collectively to classify patients based on their overall gait profile, which assisted in identifying differences between patients’ likelihood of goal attainment after treatment.

• BoNT-A, botulinum toxin type A
• Botulinum toxins
• Botulinum toxins, type A
• CI, confidence interval
• GAS, Goal Attainment Scaling
• Gait
• Goals
• LPA, latent profile analysis
• Lower extremity
• MAS, Modified Ashworth Scale
• Muscle spasticity
• OR, odds ratio
• Rehabilitation
• Stroke

The main purpose of the present study was to assess the effects of foot drop stimulators (FDS) in individuals with stroke by means of spatio-temporal and step-to-step symmetry, harmonic ratio (HR), parameters obtained from trunk accelerations acquired using a wearable inertial sensor. Thirty-two patients (age: 56.84 ± 9.10 years; 68.8% male) underwent an instrumental gait analysis, performed using a wearable inertial sensor before and a day after the 10-session treatment (PRE and POST sessions). The treatment consisted of 10 sessions of 20 min of walking on a treadmill while using the FDS device. The spatio-temporal parameters and the HR in the anteroposterior (AP), vertical (V), and mediolateral (ML) directions were computed from trunk acceleration data. The results showed that time had a significant effect on the spatio-temporal parameters; in particular, a significant increase in gait speed was detected. Regarding the HRs, the HR in the ML direction was found to have significantly increased (+20%), while those in the AP and V directions decreased (approximately 13%). Even if further studies are necessary, from these results, the HR seems to provide additional information on gait patterns with respect to the traditional spatio-temporal parameters, advancing the assessment of the effects of FDS devices in stroke patients.

• foot drop stimulation
• gait
• inertial measurement sensor
• stroke
• symmetry

• Aged
• Biosensing Techniques
• Electric Stimulation
• Female
• Gait
• Humans
• Male
• Middle Aged
• Peroneal Neuropathies/therapy
• Stroke/complications
• Stroke/therapy
• Wearable Electronic Devices

• Electric stimulation
• Lower extremity
• Neurologic gait disorders
• Stroke rehabilitation

• Botulinum neurotoxin
• IncobotulinumtoxinA
• Lower limb
• Pes equinovarus
• Rehabilitation
• Spasticity

We evaluated quality of life among subjects with upper- and lower-limb spasticity who received escalating doses of incobotulinumtoxinA (total body doses up to 800 U) in the prospective, single-arm, dose-titration TOWER study.

In this exploratory trial, subjects (N = 155; 18–80 years of age) with upper- and lower-limb spasticity due to cerebral causes who were deemed to require total body doses of up to 800 U incobotulinumtoxinA received three consecutive injection cycles of incobotulinumtoxinA (400, 600, and up to 800 U), each with 12 to 16 weeks’ follow-up. QoL was assessed using the EuroQol 5-dimensions questionnaire, three-level (EQ-5D), before and 4 weeks post-injection in each injection cycle and at the end of injection cycle 3.

The mean EQ-5D visual analog scale scores of 155 participants continuously improved from study baseline to 4 weeks post-injection in all injection cycles (mean [standard deviation] change 6.7 [14.1], 9.6 [16.3], and 8.6 [17.0] for injection cycles 1, 2, and 3, respectively; p < 0.0001 for all, paired sample t-test). In general, among those with a change in the EQ-5D rating of their condition, the proportion of subjects with ‘improvement’ was greater than that with ‘worsening’ for individual EQ-5D dimensions across all injection cycles. At the end of injection cycle 3, the proportion of subjects rating their condition as ‘normal’ increased from study baseline for all dimensions, and there was a ≥ 46% reduction in the proportion of subjects with a rating of ‘severe impairment’.

These preliminary results suggest that escalating incobotulinumtoxinA doses up to 800 U are associated with improvement in quality of life ratings in subjects with multifocal upper- and lower-limb spasticity, and form a basis for future comparator studies.

ClinicalTrials.gov, NCT01603459. Date of registration: May 22, 2012.

• Botulinum neurotoxin
• IncobotulinumtoxinA
• Long-term care
• Lower limb
• Quality of life
• Spasticity
• Spasticity management
• Upper limb

• Botulinum toxins
• Postural balance
• Rehabilitation
• Stroke

Background: The reduction of muscle hypertonia and spasticity, as well as an increase in mobility, is an essential prerequisite for the amelioration of physiotherapeutical treatments. Repetitive peripheral magnetic nerve stimulation (rPMS) is a putative adjuvant therapy that improves the mobility of patients, but the underlying mechanism is not entirely clear.

Methods: Thirty-eight participants underwent either an rPMS treatment (N = 19) with a 5 Hz stimulation protocol in the posterior tibial nerve or sham stimulation (N = 19). The stimulation took place over 5 min. The study was conducted in a pre-test post-test design with matched groups. Outcome measures were taken at the baseline and after following intervention.

Results: The primary outcome was a significant reduction of the reflex activity of the soleus muscle, triggered by a computer-aided tendon-reflex impact. The pre-post differences of the tendon reflex response activity were −23.7% (P < 0.001) for the treatment group. No significant effects showed in the sham stimulation group.

Conclusion: Low-frequency magnetic stimulation (5 Hz rPMS) shows a substantial reduction of the tendon reflex amplitude. It seems to be an effective procedure to reduce muscular stiffness, increase mobility, and thus, makes the therapeutic effect of neuro-rehabilitation more effective. For this reason, the 5 Hz rPMS treatment might have the potential to be used as an adjuvant therapy in the rehabilitation of gait and posture control in patients suffering from limited mobility due to spasticity. The effect observed in this study should be investigated conjoined with the presented method in patients with impaired mobility due to spasticity.

• cerebral palsy
• magnetic stimulation
• muscle hypertonia
• muscle spasticity
• pain
• reflex

• Botulinum Toxins, Type A/therapeutic use
• Humans
• Injections, Intramuscular
• Lower Extremity/physiopathology
• Muscle Spasticity/drug therapy
• Muscle Spasticity/physiopathology
• Muscle, Skeletal/drug effects
• Muscle, Skeletal/physiopathology
• Neuromuscular Agents/therapeutic use
• Stroke/complications
• Stroke/physiopathology
• Treatment Outcome

• Clinical practice
• Electromyography
• Intersegmental coordination
• Joint dynamics
• Kinematics
• Muscle overactivity
• Spastic paresis
• Stroke
• Upper motor neuron syndrome

The term movement disorders encompasses all disorders hypokinetic and hyperkinetic, which were previously known as extrapyramidal syndromes. With the definition of movement disorders and their diagnostic criteria and classifications, new studies for therapeutics could be performed. New drugs were launched, functional neurosurgery was developed, and the introduction of botulinum toxin (BoNT) for hyperkinesias was introduced. BoNT is an important therapy for dystonia, tics, myoclonus, and tremors. The aim of this review is to present the new and well-established uses of BoNT for movement disorders.

• Parkinson’s disease
• botulinum toxin
• dystonia
• hyperkinesias
• movement disorders
• spasticity

Post-stroke lower limb spasticity (PSLLS) has a prevalence of 28–37%. PSLLS can cause difficulty in walking and reduce quality of life (QOL). Post stroke spasticity impairs the ability to intervene to improve walking ability. Botulinum Toxin A (BT) is an effective intervention for focal spasticity, but its use is currently restricted in many countries by their reimbursement system stating that the evidence for improvement in walking and quality of life (QOL) is not robust for treatment in the lower limb. This randomized control trial (RCT) will investigate the effectiveness of BT in modifying spasticity, and improving functioning (mobility, walking, activities of daily living (ADL’s) and QOL.

A double-blind placebo-controlled trial injection will assess the effect of BT compared with a placebo (normal saline) in a sample of n = 94 patients. Following treatment of spasticity measured by Modified Ashworth Scale (MAS), the primary outcome of gait velocity will be measured by i) Gait Rite (Electronic Walkway); ii) walking by 2 Min Walk Test; iii) balance by Berg Balance Scale; mobility by iv) Timed Up and Go (TUG); v) lower limb function by ABILICO; vi) patient related goal by Goal Attainment Scale (GAS); vii) QOL by SF 12 (Rand version); viii) activities of daily living by the Functional Autonomy Measurement System (SMAF). There will be an associated health economic analysis.

The study methodology is based on our systematic review 2026 studies, which concluded the evidence for improving mobility following use of BT to reduce spasticity was not robust. The results of this study could establish the use of BT in improving gait and lower limb function in PSLLS. This study could provide the evidence needed for reimbursement schemes to consider and changes to its funding policy for BT in PSLLS.

The trial is registered with the Australia New Zealand Clinical Trails Registry (ANZCTR)-ANZCTRN12617001603303. Registered 07/12/2017.

• Botulinum toxin
• Lower limb spasticity
• Quality of life
• Stroke
• Walking

• Electromyography
• Kinematics
• Kinetics
• Spatiotemporal
• Walking

Botulinum toxin A (BoNT-A) has been shown effective for poststroke lower limb spasticity. Following injections, a wide range of multidisciplinary approach has been previously provided. The purpose of this pilot, single-blind, randomized controlled trial was to determine whether BoNT-A combined with a regime of a four-week ankle isokinetic treatment has a positive effect on function and spasticity, compared with BoNT-A alone. Secondly, the validity of the use of an isokinetic dynamometer to measure the stretch reflex at the ankle joint and residual strength has been investigated. Twenty-five chronic stroke patients were randomized to receive combined treatment (n = 12; experimental group) or BoNT-A alone (n = 13; control group). Outcome measures were based on the International Classification of Functioning, Disability and Health. An isokinetic dynamometer was also used for stretch reflex and strength assessment. Patients were evaluated at baseline (t0), after five (t1) and eight weeks after the injection (t2). The experimental group reported significantly greater improvements on lower limb spasticity, especially after eight weeks from baseline. Gait speed (10-m walk test) and walking capacity (6-min walking test) revealed statistically significantly better improvement in the experimental than in control group. Peak resistive ankle torque during growing angular velocities showed a significant reduction at the higher velocities after BoNT-A injections in the experimental group. Peak dorsiflexor torque was significantly increased in the experimental group and peak plantarflexor torque was significantly decreased in control group. Alternative rehabilitation strategies that combine BoNT-A and an intense ankle isokinetic treatment are effective in reducing tone and improving residual strength and motor function in patients with chronic hemiparesis.

• BoNT-A
• botulinum toxin A
• equinus foot
• isokinetic
• poststroke
• spasticity

• Aged
• Botulinum Toxins, Type A/therapeutic use
• Chronic Disease
• Exercise Therapy
• Female
• Foot/physiopathology
• Humans
• Male
• Middle Aged
• Muscle Spasticity/drug therapy
• Muscle Spasticity/physiopathology
• Muscle Spasticity/rehabilitation
• Neuromuscular Agents/therapeutic use
• Pilot Projects
• Single-Blind Method
• Stroke/drug therapy
• Stroke/physiopathology
• Stroke Rehabilitation
• Walking

Inconsistent data have been reported for the effectiveness of intramuscular botulinum toxin type A (BTXA) in patients with limb spasticity after stroke. This meta-analysis of available randomized controlled trials (RCTs) aimed to determine the efficacy and safety of BTXA in adult patients with upper and lower limb spasticity after stroke.

An electronic search was performed to select eligible RCTs in PubMed, Embase, and the Cochrane library through December 2018. Summary standard mean differences (SMDs) and relative risk (RR) values with corresponding 95% confidence intervals (CIs) were employed to assess effectiveness and safety outcomes, respectively.

Twenty-seven RCTs involving a total of 2,793 patients met the inclusion criteria, including 16 and 9 trials assessing upper and lower limb spasticity cases, respectively. For upper limb spasticity, BTXA therapy significantly improved the levels of muscle tone (SMD=-0.76; 95% CI -0.97 to -0.55; P<0.001), physician global assessment (SMD=0.51; 95% CI 0.35-0.67; P<0.001), and disability assessment scale (SMD=-0.30; 95% CI -0.40 to -0.20; P<0.001), with no significant effects on active upper limb function (SMD=0.49; 95% CI -0.08 to 1.07; P=0.093) and adverse events (RR=1.18; 95% CI 0.72-1.93; P=0.509). For lower limb spasticity, BTXA therapy was associated with higher Fugl-Meyer score (SMD=5.09; 95%CI 2.16-8.01; P=0.001), but had no significant effects on muscle tone (SMD=-0.12; 95% CI -0.83 to 0.59; P=0.736), gait speed (SMD=0.06; 95% CI -0.02 to 0.15; P=0.116), and adverse events (RR=1.01; 95% CI 0.71-1.45; P=0.949).

BTXA improves muscle tone, physician global assessment, and disability assessment scale in upper limb spasticity and increases the Fugl-Meyer score in lower limb spasticity.

• Botulinum toxins Type A
• Evaluation
• Standardized survey

• Botulinum Toxin
• Goal Attainment Scaling
• Self-rehabilitation
• Spasticity Management
• Stroke

• Adolescent
• Adult
• Aged
• Botulinum Toxins/administration & dosage
• Botulinum Toxins/therapeutic use
• Clinical Protocols
• Combined Modality Therapy
• Female
• Humans
• Male
• Middle Aged
• Paraparesis, Spastic/etiology
• Paraparesis, Spastic/rehabilitation
• Paraparesis, Spastic/therapy
• Physical Therapy Modalities
• Self Care/methods
• Stroke/complications
• Stroke Rehabilitation/methods
• Young Adult

• French Ministry of Health

After stroke, spasticity of the rectus femoris (RF) and triceps surae (TS) muscles frequently alters the gait pattern. Knee flexion and ankle dorsiflexion in swing are often reduced, respectively called Stiff Knee Gait (SKG) and equinus. A preliminary uncontrolled study suggested that botulinum toxin type A (BTX-A) injections could improve muscle length and force generated during gait, improving inter-segmental coordination.

The aim of this randomised controlled study is thus to evaluate changes in the length of the RF and TS muscles during gait 1 month after either BTX-A or placebo injection in patients with chronic stroke, SKG and spastic equinus. The secondary aims are to evaluate peak length and peak force generated during gait, as well inter-segmental coordination assessed using the continuous relative phase method initially described by Barela et al. in patients with stroke.

This is a prospective, three-centre, randomised, placebo-controlled, triple blind study over 3 months with 4 visits. Forty patients will be included. During visits V1, V3 and V4, length and force generated by RF and TS during gait will be assessed using musculoskeletal models (MSM). Muscle force will also be assessed using an isokinetic dynamometer. Inter segmental coordination will be evaluated using 3D gait analysis and functional tests will be performed. During V2, patients will receive either an injection of BTX-A in the RF and TS muscles or a placebo injection of saline solution.

We expect an increase in peak length and a decrease in peak force generated by the RF and TS muscles in the BTX-A group 1 month post injection. Moreover, we expect these parameters to be more improved in the BTX-A than the Control group. This is the first study to assess these parameters in a randomised, controlled trial using instrumented methods (isokinetic evaluation and 3D gait analysis). The results should help to improve understanding of the mechanism(s) underlying improvements in inter-segmental coordination that have been found in many previous uncontrolled studies.

ClinicalTrials.gov: NCT01821573, First received: March 27, 2013 Last updated: September 14, 2016 Last verified: September 2016 Other Study ID Numbers: P110136 AOM11223.

• Botulinum toxin type A
• Gait
• Motion analysis
• Muscle length
• Stroke

• Botulinum toxin
• gait
• hemiparesis
• rehabilitation
• spasticity
• stroke

• Botulinum neurotoxin
• Dose
• Dystonia
• Rehabilitation
• Spasticity
• Treatment interval

• Botulinum toxin
• Lower limb
• Spasticity
• Stroke

• Lambrinudi arthrodesis
• neurogenic clubfoot
• rigid equinovarus
• triple arthrodesis

• Botulinum neurotoxin
• Hemiplegic gait
• Stroke
• Trunk muscles
• Upper trunk posture

• Balance
• Gait
• Guidelines
• Neurorehabilitation
• Physiotherapy

• Equinovarus foot
• Gait
• Neurotomy
• Posture
• Spasticity
• Stroke