Supun Kotteduwa Jayawarden, Ryan Sandarage, Jordan Farag, Carl Ganzert, Paul Winston, Patricia Mills, Rajiv Reebye
Medicine, University of British Columbia, Vancouver, Canada
DOI: 10.2340/16501977-2743

Objective: To investigate changes in hemiparetic gait parameters after treatment of elbow flexor spasticity with botulinum neurotoxin (BoNT) injection and adjunctive casting.
Design: Prospective case series.
Subjects: Ten participants with spasticity secondary to acquired brain injury (8 stroke, 2 traumatic brain injury).
Interventions: Participants received BoNT injections for their spastic elbow flexors under ultrasound guid-ance. Two weeks post-injection, an elbow stretching cast was applied for 1 week.
Outcome measures: Assessments using the Modified Ashworth Scale (MAS), Tardieu scale V1 angle of arrest at slow speed and V3 angle of catch at fast speed, 2-min walk test (2MWT), Edinburgh Gait Score scale (EGS) and video gait analysis for step-length symmetry were conducted pre-BoNT injection (t0) and at cast removal (t1). Goal attainment scale (GAS) was used to assess changes in spasticity and gait 3 months post-injection (t2).
Results: At t1, participants showed a mean increase of 16. 7° (p < 0. 01) on the Tardieu Scale V3 and a mean reduction of 0. 5 points on the MAS (p < 0. 05). There was also a mean reduction on EGS of 2. 7 points (p < 0. 05), and a mean increase on 2MWT of 3. 1 m (p < 0. 05). On the GAS, all participants report-ed impro-ved gait at t2 and 80% reported a decrease in spasticity.
Conclusion: Combining BoNT injection with casting for treatment of elbow flexor spasticity without treat-ing the lower limb may improve hemiparetic gait parameters.

Brain injury from stroke or trauma can cause spasticity, a disorder characterized by intermittent or sustained involuntary muscle activation. Spasticity contributes to gait abnormalities that may increase the risk of falls and, consequently, affect quality of life. Botulinum toxin injections are a widely accepted treatment for spasticity. Studies have suggested that applying a stretching cast after botulinum toxin injections may improve functional outcomes. This study investigated changes in gait after botulinum toxin injections and a stretching cast in a sample of 10 patients with spasticity secondary to brain injury. The results show that a combination therapy of botulinum toxin injection and casting may improve gait without treatment of the lower limbs in long-term sur-vivors of brain injury.