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Poststroke Postural Sway Improved by Botulinum Toxin: A Multicenter Randomized Double-blind Controlled Trial.

Marjorie Kerzoncuf1, Jean-Michel Viton1, Frédéric Pellas2

  • 1Aix Marseille University, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, Marseille, France.

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PubMed
Summary

Botulinum toxin injections in lower limb muscles improved postural sway in stroke survivors with hemiparesis. A dual-task assessment effectively measured this improvement in sway area, indicating enhanced balance control.

Keywords:
Botulinum toxinsPostural balanceRehabilitationStroke

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Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Biomedical Engineering

Background:

  • Stroke survivors often experience hemiparesis, leading to lower limb spasticity and impaired postural control.
  • Postural sway, a measure of balance, is significantly affected by spasticity in individuals post-stroke.

Purpose of the Study:

  • To evaluate the impact of botulinum toxin injections into lower limb muscles on postural sway in hemiparetic individuals following a stroke.
  • To determine the efficacy of botulinum toxin in managing post-stroke lower limb spasticity and its effect on balance.

Main Methods:

  • A multicenter, randomized, double-blind, placebo-controlled trial involving 40 participants with chronic post-stroke lower limb spasticity.
  • Participants received either botulinum toxin or placebo injections. Postural sway was assessed using center of pressure measurements under various conditions (eyes open, dual task, eyes closed) before and 4-6 weeks after injection.
  • Spasticity was quantified using the Modified Ashworth Scale.

Main Results:

  • Botulinum toxin treatment led to significant reductions in spasticity in the soleus and gastrocnemii muscles (P=.049 and P=.035, respectively).
  • No significant difference in sway area was observed between groups pre-treatment.
  • A significant decrease in sway area during the dual-task condition was noted in the botulinum toxin group compared to the placebo group (-3.11±6.92 vs +0.27±3.57, P=.005).

Conclusions:

  • Botulinum toxin injections targeting lower limb spasticity in post-stroke hemiparetic individuals can improve postural sway.
  • The dual-task assessment paradigm proved to be a sensitive and effective method for detecting improvements in postural control following botulinum toxin treatment.