Faculty, Staff and Student Publications

Language

English

Publication Date

11-25-2025

Journal

Toxins

DOI

10.3390/toxins17120569

PMID

41441605

PMCID

PMC12737565

PubMedCentral® Posted Date

11-25-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Post-stroke spasticity limits motor recovery and independence. Combining botulinum toxin type-A (BoNT-A) injection with intensive, task-specific robot-assisted therapy (RAT) might enhance neuroplasticity and functional gains, but its additive effect and optimal timing are uncertain. (

Methods: We systematically searched major medical databases and trial registries up to April 2025 for randomized controlled trials in adults with post-stroke spasticity comparing botulinum toxin type-A injection plus RAT with toxin injection plus conventional therapy, or RAT alone with RAT combined with toxin injection. Risk of bias was assessed using the RoB 2 tool, and findings were synthesized narratively.

Results: Seven trials (n = 229) were included. Across all studies, toxin treatment reduced spasticity within groups, whereas additional spasticity reduction with RAT versus conventional rehabilitation was inconsistent. In contrast, several lower-limb trials reported greater improvements in walking capacity and balance when RAT was added, while upper-limb trials showed comparable motor recovery across treatment arms with occasional advantages in strength and movement quality. A pilot four-arm study suggested that starting RAT around four weeks after injection may maximize upper-limb motor gains.

Conclusions: The combination of BoNT-A with RAT appears safe and is particularly promising for gait rehabilitation, but further research is needed to define optimal timing and protocols.

Keywords

Muscle Spasticity, Robotics, Humans, Stroke, Botulinum Toxins, Type A, Stroke Rehabilitation, Neuromuscular Agents, Randomized Controlled Trials as Topic, Combined Modality Therapy, Treatment Outcome

Published Open-Access

yes

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