A prospective case series was conducted to investigate changes in gait parameters in Acquired Brain Injury (ABI) patients after treatment of upper limb elbow flexor spasticity post-Botulinum toxin A (BoNT A) injection and adjunctive therapy involving casting.
Ten ABI patients (8 stroke, 2 TBI; 6M, 4F) were injected with a total of 200 units Incobotulinum toxin A (Xeomin©) into the brachialis and brachioradialis muscles under ultrasound guidance for their flexed elbow spasticity. Two weeks post-injection, an upper elbow stretching cast was applied for 1 week. Outcome measures were recorded pre-injection (t0) and at cast removal (t1) to assess changes in spasticity and gait parameters. Modified Ashworth Scale (MAS), Tardieu Spasticity Angle (TSA), maximum elbow extension range of motion (ROM), two-minute walk test (2MWT), Edinburgh gait score (EGS) and step length symmetry were recorded at each time point. Goal attainment scale (GAS) was assessed and patients were followed for 1-year post-injection.
BoNT A with casting as an adjunct treatment improved flexed elbow spasticity and functional gait parameters in ABI patients with indoor functional mobility. Adjunctive therapy may allow longer intervals between injection cycles and provide longer stretch post-injection affecting the efficacy of botulinum toxin.This study aims to guide an RCT to determine the optimal protocol for casting post-treatment of elbow spasticity in ABI patients.
Supun Kotteduwa Jayawarden– Medical Student, University of British Columbia
Carl Ganzert– Certified Orthotist, Hodgson Orthopedic Group
Patricia Mills– Clinical Assistant Professor, Faculty of Medicine, University of British Columbia
Paul Winston– President, Canadian Association of Physical Medicine and Rehabilitation
Rajiv Reebye– Clinical Associate Professor, Department of Medicine, University of British Columbia