Hemiparetic gait and changes in functional performance due to OnabotulinumtoxinA injection to lower limb muscles.
OBJECTIVE
To review gait alterations and evaluate the effects of OnabotulinumtoxinA on spatiotemporal walking parameters of patients with hemiparetic gait.


METHODS
Retrospective pre- and post-intervention analysis.


METHODS
Gait analysis laboratory in a tertiary level rehabilitation hospital.


METHODS
42 patients with hemiparesis. 19 males and 23 females, age 18-78 years were included.


METHODS
Spatiotemporal parameters collected before and within 4-10 weeks after OnabotA injection to the ankle muscles. Data was recorded at self-selected velocity on a 12 m instrumented walkway. The most common muscles injected were medial and lateral gastrocnemius, soleus and tibialis posterior. Average total OnabotulinumtoxinA dose was 320 ± 107 units.


RESULTS
Spatiotemporal parameters of walking assessed before (T0) and within 4-10 weeks post injection (T1). Paired t-test was used to compare pre- and post-intervention data. A sequential Holm-Bonferroni procedure was used to adjust for multiple comparisons and minimize the risk of type I error. Statistical significance was set at p < 0.05.


RESULTS
Statistically significant increases were seen for walking velocity (20%) (T0 = 0.40 ± 0.26 m/s and T1 = 0.48 ± 0.29 m/s; p = 0.006), and increased cadence (T0 = 63.48 ± 23.93 steps/min, and T1 = 70.88 ± 23.65 steps/min; p = 0.006) following OnabotulinumtoxinA injections.


CONCLUSIONS
This study demonstrates that injection of OnabotulinumtoxinA 320 units to ankle muscles selected with the aid of dynamic electromyography can significantly increase gait velocity and enhance functional ambulation in adults with hemiparesis due to upper motor neuron syndrome.
MossRehab Gait & Motion Analysis Laboratory and Department of PM&R MossRehab, Elkins Park, PA, USA. Electronic address: aesquena@einstein.edu.
Alberto
A
Esquenazi
MossRehab Gait & Motion Analysis Laboratory and Department of PM&R MossRehab, Elkins Park, PA, USA.
Daniel
D
Moon
MossRehab Gait & Motion Analysis Laboratory and Department of PM&R MossRehab, Elkins Park, PA, USA.
Amanda
A
Wikoff
MossRehab Gait & Motion Analysis Laboratory and Department of PM&R MossRehab, Elkins Park, PA, USA.
Patricio
P
Sale
D000293:Adolescent; D000328:Adult; D000368:Aged; D000842:Ankle; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005684:Gait / Q000187:drug effects*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000187:drug effects*; D010291:Paresis / Q000188:drug therapy*; D012189:Retrospective Studies; D055815:Young Adult
D019274:Botulinum Toxins, Type A
Gait analysis; Hemiparesis; OnabotulinumtoxinA; Spasticity