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Updated: Feb 5, 2026

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
Published on: November 9, 2016
Decreasing pediatric pain and agitation during botulinum toxin injections for spasticity with virtual reality:
Brian Chau1,2, Bradley Chi1,3, Thaddeus Wilson1
1Department of Physical Medicine and Rehabilitation, Loma Linda University Health, Loma Linda, CA, USA.
Purpose:
Recurrent botulinum toxin (BoNT) injections are used in the pediatric population for management of spasticity, but the procedure is often associated with significant pain and anxiety for patients. Non-pharmacologic treatment alternatives for procedural discomfort are limited. Immersive virtual reality (VR) has shown efficacy in treatment of procedural discomfort in pediatric patients. A retrospective chart review was performed to assess feasibility and use of treating BoNT procedure-related discomfort in pediatric patients with VR.
Methods:
Fourteen patients undergoing elective BoNT injections viewed VR videos using a mobile VR headset during the procedure. Face, Legs, Activity, Cry, Consolability scale (FLACC) scores were obtained and feedback was elicited following injections.
Results:
The VR intervention was well tolerated, and patients' guardians requested that it be used again in 9/14 cases. The remainder either had high FLACC scores despite VR and neutral or negative guardian impressions of intervention, or were unable to utilize the device.
Conclusion:
VR was helpful in reducing BoNT procedure-related discomfort in a majority of patients. Challenges with VR setup, patient tolerance, and selecting viewing experiences were identified to guide further research and use of VR in a clinical environment.
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