title: Botulinum toxin A in the treatment of spasticity: functional implications and patient selection.
abstract: OBJECTIVE
  To explore the range of functional indications and benefit of botulinum toxin A (BTA) in spastic patients.
  
  
  METHODS
  Case report of a series of patients selected for BTA treatment. Clinical information was collected in a prospective fashion on each patient.
  
  
  METHODS
  Freestanding acute rehabilitation hospital.
  
  
  METHODS
  39 consecutive patients with 40 limbs with acquired spasticity.
  
  
  METHODS
  All 39 patients received BTA injections into muscles targeted for treatment based on functional indications.
  
  
  METHODS
  Objective evaluation of outcome was measured by Ashworth Scale, goniometry, ambulation score, and brace wear scale. Subjective measures included patient self report of improvement and pain relief.
  
  
  RESULTS
  Mean BTA dose per limb was 180 units, mean number of muscles injected per limb was 2. Twenty-nine patients had subjective and/or objective improvement with treatment. Mean Ashworth Scale improvement was one point. Mean gain in active range of motion (AROM) was 17.0 degrees, and in passive range of motion (PROM) 18.4 degrees. Brace tolerance improved in 14 of 22 patients and pain relief occurred in 10 of 13 patients. There were no adverse effects, and there was no difference in duration of effect compared to dystonia patients.
  
  
  CONCLUSIONS
  BTA is a useful intervention in the treatment of spasticity, with the majority of patients demonstrating improvement on objective measures of tone and function, and reporting improvement on subjective measures. Careful patient selection will maximize functional benefit.
authors.affiliation: Braintree Hospital Rehabilitation Network, MA, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Pierson
authors.forename: D I
authors.initials: DI
authors.lastname: Katz
authors.forename: D
authors.initials: D
authors.lastname: Tarsy
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D018579:Patient Selection; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins