Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 4 , Pages 692-699, April 2008

Time Course Analysis of the Effects of Botulinum Toxin Type A on Elbow Spasticity Based on Biomechanic and Electromyographic Parameters

  • Hsin-Min Lee, PhD

      Affiliations

    • Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan, ROC
    • ,
  • Jia-Jin Jason Chen, PhD

      Affiliations

    • Institute of Biomedical Engineering, National Cheng Kung University, Taiwan, ROC
    • Corresponding Author InformationReprint requests to Jia-Jin Jason Chen, PhD, Institute of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan
    • ,
  • Yi-Ning Wu, PhD

      Affiliations

    • Institute of Biomedical Engineering, National Cheng Kung University, Taiwan, ROC
    • ,
  • Yu-Lin Wang, MD

      Affiliations

    • Chi-Mei Hospital, Tainan, Taiwan, ROC
    • ,
  • Sheng-Chih Huang, MS

      Affiliations

    • Institute of Biomedical Engineering, National Cheng Kung University, Taiwan, ROC
    • ,
  • Maria Piotrkiewicz, PhD

      Affiliations

    • Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Poland.

Abstract 

Lee H-M, Chen J-JJ, Wu Y-N, Wang Y-L, Huang S-C, Piotrkiewicz M. Time course analysis of the effects of botulinum toxin type A on elbow spasticity based on biomechanic and electromyographic parameters.

Objective

To quantify changes of elbow spasticity over time after botulinum toxin type A (BTX-A) injection in the upper extremity of stroke patients.

Design

Before-after trial in which the therapeutic effects were followed up at 2, 6, and 9 weeks after the BTX-A injection (Botox).

Setting

Hospital.

Participants

Chronic stroke patients (N=8) with upper-limb spasticity.

Intervention

BTX-A was injected in upper-limb muscles, including the biceps brachii.

Main Outcome Measures

Treatment effects were quantified as the changes in the velocity and the length dependence of hyperexcitable stretch reflexes. Manual sinusoid stretches of the elbow joint at 4 frequencies (1/3, 1/2, 1, 3/2Hz) over a movement range of 60° were performed on patients by using a portable device. The Modified Ashworth Scale (MAS), biomechanic viscosity, and the reflexive electromyography threshold (RET) of the biceps brachii were used to evaluate the degree of hypertonia.

Results

The statistical analyses of the MAS score, biomechanic viscosity, and RET revealed a significant decrease in spasticity after the injection (all P<.05). Moreover, our quantitative parameters (biomechanic viscosity, RET) revealed small changes in spasticity after the BTX-A injection that could not be observed from clinical MAS evaluations. Five of 8 subjects showed a maximal reduction in spasticity (in terms of biomechanic viscosity value) within 6 weeks after the injection, whereas it was notable that all subjects exhibited peak RET values at either 2 or 6 weeks after the injection with variable degrees of relapse of spasticity.

Conclusions

Early relapse of spasticity (within 9 weeks of the injection) can be detected from biomechanic and neurophysiologic assessments in a clinical setup. These quantitative indices provide valuable information for clinicians when making decisions to perform additional rehabilitation interventions or another BTX-A injection in the early stages of treatment.

Key Words: Botulinum toxin type A, Muscle spasticity, Rehabilitation

 

 Supported in part by National Health Research Institute of Taiwan (contract no. NHRI-EX 95-9524E1) and National Science Council of the ROC (contract nos. NSC 92-2320-B-214-001, NSC 93-2320-B-214-004).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(08)00011-7

doi:10.1016/j.apmr.2007.08.166

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 4 , Pages 692-699, April 2008

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