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). Design: 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 brachiora-dialis. 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.