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

• Published in: Archives of physical medicine and rehabilitation Vol. 85; no. 6; pp. 902 - 909
• Main Authors: Johnson, Catherine A, Burridge, Jane H, Strike, Paul W, Wood, Duncan E, Swain, Ian D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2004; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Botulinum toxin type A; Botulinum Toxins, Type A - therapeutic use; Combined Modality Therapy; Diseases of the osteoarticular system; Electric stimulation; Electric Stimulation Therapy; Female; Gait Disorders, Neurologic - physiopathology; Gait Disorders, Neurologic - therapy; Hemiplegia - physiopathology; Humans; Male; Medical sciences; Middle Aged; Muscle spasticity; Muscle Spasticity - physiopathology; Muscle Spasticity - therapy; Neurology; Neuromuscular Agents - therapeutic use; Rehabilitation; Stroke; Stroke - physiopathology; Traumas. Diseases due to physical agents; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Walking - physiology; Stroke; Rehabilitation; Botulinum toxin type A; Electric stimulation; Muscle spasticity; Nervous system diseases; Enzyme; Use; Diseases of the osteoarticular system; Electric; Cardiovascular disease; Metalloendopeptidases; Stimulation; Botulinum toxin type A: Electric stimulation: Muscle spasticity: Rehahilitation: Stroke; Traumatology; Cerebral disorder; Vascular disease; Peptidases; Foot drop; Bontoxilysin; Type; Treatment; Orthopedics; Central nervous system disease; Hydrolases; Cerebrovascular disease
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2003.08.081

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. Arch Phys Med Rehabil 2004;85:902–9. To investigate the effect of combined botulinum toxin type A (BTX) and functional electric stimulation (FES) treatment on spastic drop foot in stroke. Nonblinded randomized controlled trial. Hospitals. Consecutive sample of 21 ambulant adults within 1 year after stroke with a spastic drop foot, of whom 18 completed the study. 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. Walking speed, Physiological Cost Index, Modified Ashworth Scale, Rivermead Motor Assessment, and Medical Outcomes Study 36-Item Short-Form Health Survey. 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. 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.