Influence of botulinum toxin type A treatment of elbow flexor spasticity on hemiparetic gait.
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).


METHODS
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.
Esquenazi
Alberto
A
Gait and Motion Analysis Laboratory, MossRehab, Philadelphia, Pennsylvania, USA.
Mayer
Nathaniel
N
Garreta
Roser
R
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D016022:Case-Control Studies; D004551:Elbow Joint / Q000187:drug effects; D005260:Female; D005684:Gait / Q000187:drug effects* / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000150:complications / Q000188:drug therapy; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010291:Paresis / Q000150:complications; D011446:Prospective Studies; D013577:Syndrome; D016138:Walking / Q000502:physiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A