{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:14:07Z","timestamp":1792790047436,"version":"4.5.0"},"reference-count":63,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T00:00:00Z","timestamp":1721347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009438","name":"Neurological and Psychiatric Disorders of NCNP","doi-asserted-by":"publisher","award":["Intramural Research Grant (5-3)"],"award-info":[{"award-number":["Intramural Research Grant (5-3)"]}],"id":[{"id":"10.13039\/501100009438","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009438","name":"Neurological and Psychiatric Disorders of NCNP","doi-asserted-by":"publisher","award":["JP21K17478"],"award-info":[{"award-number":["JP21K17478"]}],"id":[{"id":"10.13039\/501100009438","id-type":"DOI","asserted-by":"publisher"}]},{"name":"JSPS KAKENHI","award":["Intramural Research Grant (5-3)"],"award-info":[{"award-number":["Intramural Research Grant (5-3)"]}]},{"name":"JSPS KAKENHI","award":["JP21K17478"],"award-info":[{"award-number":["JP21K17478"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Numerous studies have established a robust body of evidence for botulinum toxin A (BoNT-A) therapy as a treatment for upper motor neuron syndrome. These studies demonstrated improvements in spasticity, range of joint motion, and pain reduction. However, there are few studies that have focused on improvement of paralysis or functional enhancement as the primary outcome. This paper discusses the multifaceted aspects of spasticity assessment, administration, and rehabilitation with the goal of optimising the effects of BoNT-A on lower-limb spasticity and achieving functional improvement and gait reconstruction. This paper extracts studies on BoNT-A and rehabilitation for the lower limbs and provides new knowledge obtained from them. From these discussion,, key points in a walking reconstruction strategy through the combined use of BoNT-A and rehabilitation include: (1) injection techniques based on the identification of appropriate muscles through proper evaluation; (2) combined with rehabilitation; (3) effective spasticity control; (4) improvement in ankle joint range of motion; (5) promotion of a forward gait pattern; (6) adjustment of orthotics; and (7) maintenance of the effects through frequent BoNT-A administration. Based on these key points, the degree of muscle fibrosis and preintervention walking speed may serve as indicators for treatment strategies. With the accumulation of recent studies, a study focusing on walking functions is needed. As a result, it is suggested that BoNT-A treatment for lower limb spasticity should be established not just as a treatment for spasticity but also as a therapeutic strategy in the field of neurorehabilitation aimed at improving walking function.<\/jats:p>","DOI":"10.3390\/toxins16070323","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T09:14:53Z","timestamp":1721380493000},"page":"323","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Gait Reconstruction Strategy Using Botulinum Toxin Therapy Combined with Rehabilitation"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4153-168X","authenticated-orcid":false,"given":"Takatoshi","family":"Hara","sequence":"first","affiliation":[{"name":"Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7077-4261","authenticated-orcid":false,"given":"Toru","family":"Takekawa","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6701-4974","authenticated-orcid":false,"given":"Masahiro","family":"Abo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,19]]},"reference":[{"key":"ref_1","first-page":"S1","article-title":"Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion","volume":"6","author":"Mayer","year":"1997","journal-title":"Muscle Nerve Suppl."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1161\/01.STR.0000105386.05173.5E","article-title":"Spasticity after stroke: Its occurrence and association with motor impairments and activity limitations","volume":"35","author":"Sommerfeld","year":"2004","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1191\/0269215502cr512oa","article-title":"Prevalence of spasticity post stroke","volume":"16","author":"Watkins","year":"2002","journal-title":"Clin. 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