The effectiveness of physiotherapy techniques for the reduction of spasticity as an adjunct intervention alongside botulinum toxin A in post-stroke adult individuals

Details

Supervisors

Pirali, Françoise ; Dehem, Stéphanie

Faculty

Faculté des sciences de la motricité

Degree label

Master [60] en kinésithérapie et réadaptation

Abstract

Abstract : Aim : The purpose of this systematic review was to summarise available therapy modalities alongside botulinum toxin A. Methods : Three electronic databases were searched (Pubmed, Embase, Pedro) between September and December 2021. Studies were included if they were randomised controlled trials in English, published after the year 2000, with spasticity considered as the main outcome. We removed trials in which the population was not composed of stroke patients only and if the PEDro score was under 5 out of 10. Results : A total of 15 studies were included, 6 for the upper limb and 9 for the lower limb. For the lower limb part, all therapies (stretching, casting, taping, electro-stimulation, backward treadmill training, robot-assisted training and ankle isokinetic training) showed a positive impact on spasticity with the sole exception of kinesiotaping. The casting intervention particularly demonstrated its superiority in comparison to the stretching and taping protocols. Conclusions: Extracorporeal shockwave therapy, adhesive taping, modified constraint-induced movement therapy, as well as non-individualised home program implying strengthening, stretching and task-oriented exercises demonstrated benefits on spasticity levels for the upper limb. Similar results were found for the lower limb, interventions as electro-stimulation, casting, taping, backward treadmill training, robot-assisted training, stretching and ankle isokinetic training also showed their positive impact on spasticity regardless of the outcome measure used (modified Ashworth scale, Tardieu scale or modified Tardieu scale). Future longer researches are necessary to observe more precisely the benefits of the different interventions on spasticity and functionality, as well as to compare each of them using similar protocols. Keywords : Botulinum toxin A, BTA, BoNT-A, spasticity, adjuvant therapy, additional therapy, concomitant therapy, stretching, electro-stimulation, casting, taping, treadmill training, robot-assisted training, ankle isokinetic training, functional outcome measure, Modified Ashworth Scale, Tardieu scale, Modified Tardieu Scale, stroke