title: Botulinum toxin type A injection into the gastrocnemius muscle for spastic equinus in adults with stroke: a randomized controlled trial comparing manual needle placement, electrical stimulation and ultrasonography-guided injection techniques.
abstract: OBJECTIVE
  The aim of this study was to compare the clinical outcomes of manual needle placement, electrical stimulation, and ultrasonography-guided techniques for botulinum toxin injection into the gastrocnemius of adults with spastic equinus after stroke.
  
  
  METHODS
  After randomization into three groups, each patient received the same dose of botulinum toxin type A into the lateral and medial head of the gastrocnemius muscle (OnabotulinumtoxinA, 100U per head) of the affected leg. The manual needle placement group (n = 15) underwent injections using anatomic landmarks and palpation; the electrical stimulation group (n = 15) received injections with electrical stimulation guidance; and the ultrasonography group (n = 17) was injected under sonographic guidance. The modified Ashworth scale, the Tardieu scale, and the ankle passive range of motion were measured at baseline and 1 mo after injection. Nonparametric statistical analysis was used.
  
  
  RESULTS
  One month after injection, the modified Ashworth scale improved better in the ultrasonography group than in the manual needle placement group (P = 0.008). The ankle passive range of motion improved better in the ultrasonography group than in the electrical stimulation (P = 0.004) and manual needle placement (P < 0.001) groups. No difference was found between groups for the Tardieu scale.
  
  
  CONCLUSIONS
  Ultrasonography-guided injection technique could improve the clinical outcome of botulinum toxin injections into the gastrocnemius of adults with spastic equinus.
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamburin
authors.forename: Paola
authors.initials: P
authors.lastname: Bonetti
authors.forename: Carla
authors.initials: C
authors.lastname: Fontana
authors.forename: Martina
authors.initials: M
authors.lastname: Barausse
authors.forename: Francesca
authors.initials: F
authors.lastname: Dambruoso
authors.forename: Francesca
authors.initials: F
authors.lastname: Gajofatto
authors.forename: Valter
authors.initials: V
authors.lastname: Santilli
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D016059:Range of Motion, Articular; D020521:Stroke / Q000150:complications*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A