Does Spasticity Reduction by Botulinum Toxin Type A Improve Upper Limb Functionality in Adult Post-Stroke Patients? A Systematic Review of Relevant Studies

Spasticity is a common disabling disorder that occurs from 17 to 43% in patients with stroke affecting both the upper and the lower limb [1-4]. If left untreated, it can hamper functional outcome by promoting persistent abnormal posture that in turn produces muscular-tendon contractures and bone deformity. Several functional limitations arise from spasticity including impaired movement, hygiene, self-care, poor self-esteem, body image, pain and pressure ulcers that increase carer burden. Furthermore, patients with severe spasticity can develop poor social participation and quality of life (QOL) [5]. Because of these concerns and related high social costs [6], many therapeutic strategies have been proposed for the treatment of this disorder including surgical, medical and rehabilitative procedures. Among these, botulinum toxin type A (BTX-A) is became the first line to treat focal/multifocal spasticity, in the clinical practice. There is now, a well-established body of evidence demonstrating the effectiveness of BTX-A for post-stroke spasticity reduction both in the upper and the lower limb [7-18]. Nevertheless, its impact on motor performance and functional outcome remains controversial [19,20]. In particular, the effect of reduced spasticity on upper limb ability recovery after stroke is unclear. The central thread in treating spasticity is the assumption that it contributes to the limitation of activities, and that its reduction will bring about an improvement in function. The aim of present review was to ascertain if the reduction of spasticity by use of BTX-A was linked to a functional gain in upper limb or in activity of daily living in post-stroke patients. Therefore, relevant studies addressing upper limb (UL) spasticity reduction and functional improvement after BTX-A treatment in adult post-stroke patients were reviewed. Method