Volume 89, Issue 5 , Pages 982-987, May 2008
Comparative Impact of 2 Botulinum Toxin Injection Techniques for Elbow Flexor Hypertonia
Abstract
Mayer NH, Whyte J, Wannstedt G, Ellis CA. Comparative impact of 2 botulinum toxin injection techniques for elbow flexor hypertonia.
Objective
To compare 2 techniques of botulinum toxin injection for elbow flexor hypertonia.
Design
Parallel-group, randomized, controlled trial with blinded outcome assessment.
Setting
Laboratory, tertiary rehabilitation hospital.
Participants
Adults (N=31) with acquired brain injury (21 with traumatic brain injury, 8 with stroke, 2 with hypoxic encephalopathy) provided 36 sets of elbow flexors with Ashworth Scale scores equal to 3.
Intervention
Botulinum toxin type A (BTX-A) was injected with a motor point or a multisite injection technique after obtaining 2 baseline evaluations of the main outcome measures. Motor point technique involved decremental electric stimulation with delivery of 60U of BTX-A (Botox) in 2.4mL or 30U BTX-A in 1.2mL of preservative-free saline at single biceps and brachioradialis motor points, respectively. Distributed injection was performed using electromyographic feedback. Fifteen units in 0.6mL were delivered to each of 4 biceps sites and 2 brachioradialis sites. Total dose (90U) and total injection volume (3.6mL) were identical across groups. Only sites and injection techniques varied. The brachialis was not injected in either group.
Main Outcome Measures
Ashworth Scale, Tardieu catch angle, and root mean square surface electromyographic activity of the biceps, brachialis, and brachioradialis.
Results
Postintervention testing at 3 weeks showed no significant differences between groups (P range, .31–.82 across 3 outcome measures). However, within each group, significant treatment effects were observed on all outcome measures (all P<.01). For the uninjected brachialis muscle, electromyographic reduction was greater for the distributed group.
Conclusions
In 31 adults with acquired brain injury, single motor point and multisite distributed injections of low-dose, high-volume BTX-A had similar impact. Findings suggest that low-dose, high-volume strategies may have a potential role in reducing drug cost and helping clinicians stay within accepted limits for total body dose in patients with upper motoneuron syndrome requiring many injections.
Key Words: Botulinum toxins, Brain injuries, Injections, Muscle hypertonia, Rehabilitation
Supported in part by the National Institute on Disability and Rehabilitation Research (grant no. H133A020505) and an educational grant from Allergan Inc.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.Reprints are not available from the authors.
PII: S0003-9993(08)00071-3
doi:10.1016/j.apmr.2007.10.022
© 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Volume 89, Issue 5 , Pages 982-987, May 2008
