title: Modification of altered ankle motor control after stroke using focal application of botulinum toxin type A.
abstract: METHODS
  Blinded, placebo-controlled, prospective clinical trial.
  
  
  OBJECTIVE
  To examine the effects of botulinum toxin type A (BTX-A) injections into plantar flexor muscles in stroke patients with equinovarus gait.
  
  
  METHODS
  15 post-stroke and 10 matched neurologically intact subjects.
  
  
  METHODS
  Modified Ashworth Scale (MAS) and Fugl-Meyer assessment of physical function scale scores along with surface EMG collected before and up to 12 weeks after BTX-A injections to plantar flexor muscle motor points in stroke subjects. Saline placebo injections were performed in a subset of stroke subject group.
  
  
  RESULTS
  MAS scores were decreased at 4, 8 and 12 weeks but F-M scores did not improve until 12 weeks post injection. Multi-muscle EMG patterns showed the return of volitional dorsiflexor activity in 11 and a decrease of antagonistic and distant coactivation in all but one of the 15.
  
  
  CONCLUSIONS
  BTX-A is effective in reducing antagonistic and distant muscle activation that impedes volitional dorsiflexion.
authors.affiliation: Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan County, Taiwan.
authors.forename: Simon F
authors.initials: SF
authors.lastname: Tang
authors.forename: Jia-Pei
authors.initials: JP
authors.lastname: Hong
authors.forename: William Barry
authors.initials: WB
authors.lastname: McKay
authors.forename: Chu-Wen
authors.initials: CW
authors.lastname: Tang
authors.forename: Pei-Hsuan
authors.initials: PH
authors.lastname: Wu
authors.forename: Ngok-Kiu
authors.initials: NK
authors.lastname: Chu
mesh_terms: D000368:Aged; D000842:Ankle / Q000503:physiopathology*; D000843:Ankle Joint / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003714:Denervation; D004311:Double-Blind Method; D004576:Electromyography; D015444:Exercise; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy; D006429:Hemiplegia / Q000209:etiology / Q000628:therapy; D006801:Humans; D007717:Knee / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009068:Movement; D009069:Movement Disorders / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D020521:Stroke / Q000150:complications*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A