Efficacy of therapeutic ultrasound and transcutaneous electrical nerve stimulation compared with botulinum toxin type A in the treatment of spastic equinus in adults with chronic stroke: a pilot randomized controlled trial.
BACKGROUND
Therapeutic ultrasound and transcutaneous electrical nerve stimulation (TENS) have been described as being effective in the treatment of spasticity. No previous study compared these physical modalities with a first-line treatment for spasticity, such as botulinum toxin type A.


OBJECTIVE
To compare the effects of therapeutic ultrasound and TENS with botulinum toxin type A on spasticity after stroke.


METHODS
Thirty patients with chronic stroke and spastic equinus were randomly assigned to 3 groups: 1 group received therapeutic ultrasound to the affected leg calf muscles, 1 group underwent TENS to the tibial nerve of the affected leg, and 1 group was injected with onabotulinum toxin A in the spastic gastrocnemius. All patients were evaluated immediately before treatment and 15, 30, and 90 days after the first clinical evaluation. The following outcome measures were considered: ankle passive dorsiflexion range of motion and the modified Ashworth scale.


RESULTS
Patients injected with botulinum toxin type A had significantly better ankle passive range of motion than those treated with physical modalities at all posttreatment evaluations. At second and third posttreatment evaluations, the modified Ashworth scale indicated significantly greater improvement in patients injected with botulinum toxin type A than in those treated with physical modalities. No difference was found between groups treated with physical modalities.


CONCLUSIONS
Our findings support the hypothesis that botulinum toxin type A is more effective than therapeutic ultrasound and TENS for treating focal spasticity in patients with chronic stroke.
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
Alessandro
A
Picelli
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
Francesca
F
Dambruoso
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
Manoj
M
Bronzato
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
Martina
M
Barausse
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy Neurological Rehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Marialuisa
M
Gandolfi
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy Neurological Rehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Nicola
N
Smania
D000368:Aged; D000842:Ankle / Q000473:pathology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy / Q000534:rehabilitation* / Q000628:therapy; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D016059:Range of Motion, Articular; D020521:Stroke / Q000188:drug therapy / Q000628:therapy; D000071939:Stroke Rehabilitation; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D014465:Ultrasonics
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
calf muscles; physical therapy modalities; rehabilitation; spasticity