Multidimensional evaluation of changes in limb function following botulinum toxin injection in persons with stroke

Area of Science:

• Neurorehabilitation
• Movement Science
• Clinical Neurology

Background:

• Limited evidence exists on instrumented gait and balance measures for assessing botulinum toxin type A (BoNT-A) functional effects in post-stroke spasticity.
• Stroke-related spasticity significantly impacts motor function, gait, and balance, necessitating effective treatment strategies.

Purpose of the Study:

• To evaluate functional changes in gait and balance after upper and lower limb BoNT-A treatment in stroke patients.
• To assess the efficacy of BoNT-A in improving objective and subjective measures of physical activity and motor function.

Main Methods:

• A prospective, pre-post study design involving 35 stroke patients with upper and/or lower limb spasticity.
• Focal BoNT-A treatment administered, with assessments at baseline, 6 weeks (T1), and 12 weeks (T2).
• Utilized validated subjective and objective measures, including instrumented gait and balance assessments and physical activity monitors.

Main Results:

• Significant improvements observed in impairment, activity, and participation domains at 6 weeks (p < 0.05, r = 0.5-0.9).
• Increased low-intensity physical activity and reduced sedentary time noted at follow-up.
• Instrumented gait analysis showed increased cadence and turn velocity; however, posturography revealed no significant changes in sway measures.

Conclusions:

• BoNT-A improved most clinical spasticity measures and some objective physical activity and gait parameters.
• Benefits in clinical outcomes were largely maintained at 12 weeks.
• Larger studies are needed to definitively establish BoNT-A benefits for objective gait and balance in stroke-related spasticity.