The impact of post-stroke spasticity and botulinum toxin on standing balance: a systematic review

Abstract

Although falls, balance impairment, and spasticity are common post-stroke, their interrelationship remains unclear. We review the literature for a) a relationship between spasticity and balance and b) the effect of botulinum toxin injections on balance. Electronic databases were searched based on two criteria: a) studies assessing balance in subjects with spasticity and b) studies examining the effect of botulinum toxin on balance. The primary findings were a) balance is impaired in subjects with spasticity, but only one study assessed relationship between spasticity and balance; and b) four studies reported that balance improves following botulinum treatment for limb spasticity. Persons with spasticity demonstrate impaired balance, but the correlation between spasticity and balance has not been adequately assessed in the literature. Evidence for balance changes following botulinum toxin is weak because of lack of randomization, control group comparison, objective balance assessment measures, and standard clinical scales.

Keywords::

• balance
• botulinum toxin
• chemodenervation
• spasticity
• stroke
• systematic review

Financial & competing interests disclosure

CP Phadke and G Mochizuki have received post grant support from Allergan Inc. F Ismail and C Boulias have received post grant support and payment for lectures and presentations from Allergan Inc. C Phadke has received support from the West Park Foundation. G Mochizuki has received support from the Kevin Duffy Stroke Rehabilitation Scientist award and from the Heart and Stroke Foundation Centre for Stroke Recovery. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Patients with stroke can experience spasticity together with balance impairments; however, their relationship is not clear.

• Spasticity and balance impairments are weakly correlated in patients with low-level balance impairment.

• The relationship in patients with higher degree of balance impairments is not known.

• Studies reviewed here included only subjects with mild balance impairments.

• Balance can improve after the administration of botulinum toxin; however, only subjective tests were used in the studies reviewed here.

• Lack of objective tests as well as quantitative assessment of balance impairment using force plates, for example, makes it difficult to draw any definitive conclusions.

• Future research needs to focus on understanding the extent of balance impairments in patients with spasticity.

• Randomized controlled trials are needed using quantitative assessments of balance as well as spasticity.

Notes