Mk. Childers et al., COMPARISON OF 2 INJECTION TECHNIQUES USING BOTULINUM TOXIN IN SPASTICHEMIPLEGIA, American journal of physical medicine & rehabilitation, 75(6), 1996, pp. 462-469
This study sought to test the hypothesis that injections of botulinum
toxin type A (BTX-A) at the mid belly of the gastrocnemius muscle in s
pastic hemiplegic adults produce superior clinical results to proximal
injections directed toward the muscular origin. We designed a randomi
zed, double-blind, placebo-controlled intervention study at a universi
ty tertiary care setting. Seventeen subjects with chronic spastic hemi
plegic gait were enrolled from a volunteer community sample; time rang
e from acute neurologic insult was 0.75 to 31 yr; age range was 19 to
71 yr; gender consisted of 11 men and 4 women; diagnoses were 12 patie
nts with stroke, 2 with traumatic brain injuries, and 1 with a brain t
umor, Two subjects were withdrawn from the study because of (1) acute
vascular occlusion before intervention and (2) noncompliance with foll
ow-up visits. After baseline measurements, subjects were injected with
50 units of BTX-A (volume, 0.5 cc) into the medial or lateral gastroc
nemius: (1) proximally at one site near the muscular origin; (2) dista
lly at three sites along the mid belly. We measured outcome using the
Fugl-Meyer score, Ashworth scale, ankle range of motion, and a timed 5
0-ft fastest walk. No outcome measures showed a significant effect att
ributable to site of injections. Confounding variables included physic
al therapy and varying duration of illness in the study cohort. We con
clude that the results failed to support the hypothesis that BTX-A inj
ections at the mid belly of the gastrocnemius produced superior functi
onal improvements to injections located near the muscular origin using
localization techniques described. Additional research comparing more
precise localization methods for BTX-A injections might Further estab
lish the importance of electromyographic guidance using BTX-A in manag
ement of spasticity.