Combined effects of robot‑assisted gait training and botulinum toxin type A on spastic equinus foot in patients with chronic stroke: a pilot, single blind, randomized controlled trial.
BACKGROUND
Despite the growing evidence about the use of robotic gait training in neurorehabilitation, there is a scant literature about the combined effects of this innovative technological approach and a first‑line treatment for focal spasticity as botulinum toxin type A. In particular, to the best of our knowledge, no previous study evaluated if robotic gait training may enhance the antispastic effect of botulinum toxin type A.


OBJECTIVE
To evaluate the combined effects of robot‑assisted gait training and botulinum toxin type A on spastic equinus foot in patients with chronic stroke.


METHODS
Pilot, single blind, randomized controlled trial.


METHODS
University hospital.


METHODS
Twenty‑two adult outpatients with spastic equinus due to chronic stroke.


METHODS
Participants were randomly assigned to two groups: patients allocated to the group 1 received robot‑assisted gait training (30 minutes a day for five consecutive days) after AbobotulinumtoxinA injection into the spastic calf muscles as well as patients allocated to the group 2 were only injected with AbobotulinumtoxinA into the same muscles. All patients were evaluated immediately before and one month after injection. The following outcome measures were considered: the modified Ashworth scale, the Tardieu scale and the 6-minute walking test.


RESULTS
No difference was found between groups as to the modified Ashworth scale and the Tardieu scale measured at the affected ankle one month after botulinum toxin injection. A significant difference in the 6-minute walking test was noted between groups at the post‑treatment evaluation (P=0.045).


CONCLUSIONS
Our preliminary findings support the hypothesis that robot‑assisted gait training does not enhance the effect of botulinum toxin type A on spastic equinus foot in patients with chronic stroke.


CONCLUSIONS
Our observations should be taken into account in daily clinical rehabilitation practice in order to develop effective treatment protocols based on the enhancement of antispastic drugs effect.
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy - alessandro.picelli@univr.it.
Alessandro
A
Picelli
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Marco
M
Bacciga
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Camilla
C
Melotti
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Elisabetta
E
LA Marchina
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Elisabetta
E
Verzini
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Federico
F
Ferrari
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Angelo
A
Pontillo
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Jessica
J
Corradi
Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Stefano
S
Tamburin
Department of Neurology, Hochzirl Hospital, Zirl, Austria.|Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy.
Leopold
L
Saltuari
Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy.|Department of Rehabilitation, Brunico Hospital, Brunico, Italy.
Claudio
C
Corradini
Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy.|Villa Melitta Rehabilitation Clinic, Bolzano, Italy.
Andreas
A
Waldner
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.|Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy.
Nicola
N
Smania
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005528:Foot; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010865:Pilot Projects; D016059:Range of Motion, Articular; D012371:Robotics / Q000379:methods*; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A