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Table 4.18 Multimodal Interventions for the Treatment of Spasticity Post ABI.

Author, Year Country Study Design Sample Size Methods Outcome
Leung et al. (2014) Australia RCT PEDro=8 NInitial=35, NFinal=32   Population: TBI; Experimental Group (EG; n=17): Mean Age=38yr; Gender: Male=14, Female=3; Mean Time Post Injury=140d; Mean GCS=5. Control Group (CG; n=18): Mean Age=38yr; Gender: Male=15, Female=3; Mean Time Post Injury=83d; Mean GCS=5. Intervention: Participants were randomly allocated to either the EG or CG group. The EG group underwent a treatment of tilt table standing and electrical stimulation (30 min 5d/wk) and splinting (12hr 5d/wk) for a total of 6 wk. For the next 4wk EG group participants underwent tilt table standing alone (30 min 3d/wk). The CG group underwent tilt table standing (30min 3d/wk) for the full 10 wk. Measures were taken at baseline, 6wk and 10wk. Outcome Measure: Passive ankle dorsiflexion, Functional Independence Measure (FIM). 1.        The CG group had a greater range of motion for passive ankle dorsiflexion than the EG group at 6 wk (3 degrees) and 10 wk (-1 degree). 2.        The EG group had a greater mean reduction in spasticity (1 point) at 6 wk; however, the effect disappeared at 10 wk. 3.        There was no between group differences in walking speed. 4.        There were no differences between groups for tolerance to treatment, perceived treatment benefit, perceived treatment worth, and willingness to continue with treatment.
Lorentzen et al. (2012) Denmark RCT-Crossover PEDro=6 N=10 Population: TBI=6, Stroke=2, Subarachnoid Hemorrhage=1, Post-Operative Hemorrhage=1; Mean Age=31.5yr; Gender: Male=6, Female=4; Mean Time Post Injury=3.6mo. Intervention: Participants received either Neural Tension Technique (NTT) intervention or the Random Passive Movement (RPM) treatment on knee joints. The NTT and RPM treatments lasted for 20min, with clinical tests conducted immediately before and after each intervention. Outcome measure: Modified Ashworth Scale (MAS), Range of Motion (ROM). 1.        The blinded reviewers found no significant change on the MAS for knee flexors after the NTT (Mean change=0.4–0.6, p=0.10–0.31) or the RPM (Mean change=0.4–0.5, p=0.1–0.3). No significant between group differences were found (p=0.12-0.71). 2.        No significant between or within group differences were found based on the MAS for knee extensors after the intervention. The blinded reviewers found no significant difference in ROM after RPM (p=0.13) but did for NTT (p<0.05). No significant between group differences for ROM were found (p>0.32).
Verplancke et al. (2005) UK RCT PEDro=4 N=35   Population: TBI=20, Neurosurgery=11, Anoxia=4; Gender: Male=25, Female=10. Group 1 (n=11): Median Age=40yr; Mean Time Post Injury=9.3d, Mean Glasgow Coma Scale (GCS) score 4.3. Group 2 (n=12): Median Age=33.5yr; Mean Time Post Injury=13.25 days; Mean GCS score=4.7. Group 3 (n=12): Median Age=41.5yr; Mean Time Post Injury=10.6d; Mean GCS score=5.2. Intervention:  Participants entered one of three groups: group 1 received a physical intervention (controls), group 2 received casting plus injections of saline (4 ml), and group 3 received casting with botulinum toxin (100 units per leg) into the gastrocnemius and soleus muscles. Patients were re-cast if a 10° change in dorsiflexion occurred. Outcome Measure: Calf contracture, Modified Ashworth Scale (MAS), Passive Range of Motion. 1.        Eighty-eight percent of patients developed spasticity within 14 days of injury. 2.        Mean change in angle of passive ankle dorsiflexion was 4.59° in controls, 11.69° in group 2 and 13.59° in group 3. 3.        There were significant improvements in MAS scores in treated groups (group 2, p<0.03; group 3, p=0.04) but not controls (p>0.05).
Leung et al. (2019) Australia RCT PEDro=7 NInitial=13, NFinal=11 Population: TBI=13; Intervention Group (n=7): Median Age=27yr (27-57); Gender: Male=3, Female=7; Median Time Post Injury=125d (78-150); Severity: Median GCS=3 (3-4). Control Group (n=6): Median Age=39yr (28-53); Gender: Male=3, Female=3; Median Time Post Injury=113d (73-159); Severity: Median GCS=9 (3-9) Intervention: Participants in the intervention group received botulinum toxin injections and serial casting, while those in the control group were placed on a waiting list for six weeks and then received the same intervention. Both groups received splinting and motor training following serial casting. Outcome measures were assessed at baseline, completion of casting, 2 and 8wk after casting. Outcome Measures: Passive ankle dorsiflexion range, spasticity, ankle dorsiflexor strength, Functional Independence Measure (FIM).  1.        Passive ankle dorsiflexion range significantly improved following completion of casting (26°, 95% CI: 20-31) and improvements were sustained at 2 (26°, 95% CI: 18-33) and 8wk (24°, 95% CI: 19-30) following casting. 2.        No significant between groups differences were observed for strength and spasticity (p>.05).