Influence of Botulinum Toxin Type A Treatment of Elbow Flexor Spasticity on Hemiparetic Gait

Esquenazi A, Mayer N, Garreta R: Influence of botulinum toxin type A treatment of elbow flexor spasticity on hemiparetic gait. Am J Phys Med Rehabil 2008;87:305–311. Objective:To assess whether walking velocity could be improved in patients with disorders related to upper–motor neuron syndrome (UMNS) by treating elbow flexor spasticity with botulinum toxin type A (BoNTA). Design:This was a prospective, open-label, multicenter, interventional evaluation. The study group of 15 patients (mean age, 51.3 yrs; ten men, five women) were independent ambulators with residual hemiparesis attributable to stroke or traumatic brain injury of at least 18-mo duration. Patients were injected with 120–200 units of BoNTA (BOTOX, Allergan, Inc., Irvine, CA) to the affected biceps, brachialis, and/or brachioradialis. Modified Ashworth scores and gait velocity were assessed before and after BoNTA treatment. An untreated control group was employed to assess the potential impact of time on test–retest reliability of the selected temporal spatial gait parameters. Results:The BoNTA group demonstrated a statistically significant increase in walking velocity from 0.56 m/sec before treatment to 0.63 m/sec after treatment (P = 0.037). The mean modified Ashworth score was significantly reduced from 2.6 before BoNTA treatment to 1.4 after treatment (P = 0.00003). Conclusions:Treatment of upper-limb spasticity may be an important adjuvant treatment for patients with gait disturbance related to the UMNS.

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