Botox - Body Structure & Function

The results from a systematic review (Lannin et al, 2006) found that electrical stimulation after Botox had no significant effect on gait parameters. An international consensus statement (Lovea et al, 2010) reported that there is insufficient quality evidence to support the use of physiotherapy as an adjunct to Botox injections to improve gait parameters.

Conclusion: There is limited (level 2b) evidence from a systematic review indicating that physical therapy modalities in adjunct to Botox do not further enhance gait parameters as compared to Botox alone.

A high level RCT (Rameckers et al, 2009) evaluated the effects of physical therapy, occupational therapy and Botox on the range of motion, spasticity and manual skills in children with hemiplegia. During therapy, AROM of the wrist increased and gain was maintained at follow-up. No significant between-group differences were found.

A high level RCT (Wallen et al, 2007) investigated the functional outcomes of Botox injections to the upper limb in combination with occupational therapy (OT) in children with cerebral palsy. Subjects were separated into three group: Botox alone, Botox and OT, OT alone. Active supination was demonstrated to increase in the Botox group and in the Botox and OT group and gains were maintained at 6 months post intervention.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs indicating that Botox and rehabilitation therapy improve range of motion in children with cerebral palsy. However additional research is needed to demonstrate whether these gains are more significant than using Botox alone.

A high level RCT (Rameckers et al, 2009) evaluated the effects of physical therapy, occupational therapy and botox on the range of motion, spasticity and manual skills in children with hemiplegia. Stretch resistance angle of the wrist and elbow improved and gain was maintained. Ashworth scale of the wrist and elbow improved at 3 and 6 months post intervention. No between group differences were noted however.

A high level RCT (Wallen et al, 2007) investigated the functional outcomes of Botox injections to the upper limb in combination with OT in children with cerebral palsy. Subjects were separated into three group: Botox alone, Botox and OT, OT alone. Scores on the Tardieu scale improved in both groups having received Botox however there were no between group differences in the two Botox groups.

The results from a systematic review (Lannin et al, 2006) found inconclusive evidence regarding the use of Botox and therapy on spasticity using the Modified Ashworth Scale as an outcome measure. However it should be noted that each study investigated different therapy techniques and thus results were difficult to synthesize.

The results of a systematic review (Hoare et al, 2010) demonstrated that a combination of Botox and occupational therapy was more effective than occupational therapy or Botox alone in reducing spasticity.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs indicating that Botox and rehabilitation therapy improve spasticity in children with cerebral palsy. However additional research is needed to demonstrate whether these improvements are more significant than using Botox alone.

A high level RCT (Rameckers et al, 2009) evaluated the effects of physical therapy, occupational therapy and Botox on the range of motion, spasticity and manual skills in children with hemiplegia. Both groups increased their force production however PT/OT group showed better capability to produce mean force at 6 months compared to Botox group. Botox group continued to show a slight increase in force at all levels, but PT/OT group displayed slight decrease once program ceased.

Conclusion: There is moderate evidence (level 1b) from one high quality RCT demonstrating that Botox and therapy improve force production.