{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T20:01:40Z","timestamp":1783972900362,"version":"3.55.0"},"reference-count":0,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Spasticity is a very common sign in the neurological field. It can be defined as \u201ca motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes\u201d associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life\u201d. The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients\u2019 performance and outcomes. The combined strategies might rise the toxin\u2019s effect, lowering its dosages of botulinum and reducing side effects and costs.<\/jats:p>","DOI":"10.3390\/brainsci14070631","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T13:06:40Z","timestamp":1719234400000},"page":"631","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0564-2320","authenticated-orcid":false,"given":"Loredana","family":"Raciti","sequence":"first","affiliation":[{"name":"Unit\u00e0 Spinale Unipolare, AO Cannizzaro, 98102 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Raciti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Gr\u00e6cia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2828-2455","authenticated-orcid":false,"given":"Antonio","family":"Ammendolia","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Gr\u00e6cia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-8346","authenticated-orcid":false,"given":"Alessandro","family":"de Sire","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Gr\u00e6cia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Pia","family":"Onesta","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Spinale Unipolare, AO Cannizzaro, 98102 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8566-3166","authenticated-orcid":false,"given":"Rocco Salvatore","family":"Calabr\u00f2","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98121 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,24]]},"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/7\/631\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:03:43Z","timestamp":1760108623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/7\/631"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,24]]},"references-count":0,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["brainsci14070631"],"URL":"https:\/\/doi.org\/10.3390\/brainsci14070631","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,24]]}}}