• Anand D Pandyan, Philippe Vuadens, Frederike M J van Wijck, Sandra Stark, Garth R Johnson, and Michael P Barnes.
• Department of Physiotherapy Studies, Keele University, Staffs, UK. a.d.pandyan@keele.ac.uk
• Clin Rehabil. 2002 Sep 1;16(6):654-60.

ObjectiveTo quantify the clinical efficacy of botulinum toxin type A in treating elbow flexor spasticity in a unilateral stroke population.LocationA spasticity clinic at a regional neurological rehabilitation centre.Study DesignA convenience sample longitudinal study. Fourteen subjects with elbow flexor spasticity secondary to a stroke were recruited. Two repeated measures, one before and another four weeks after treatment, were taken to quantify clinical efficacy.Outcome MeasuresElbow flexor spasticity was simultaneously rated with the modified Ashworth scale (MAS) and quantified by measuring the surface EMG from the flexors using a custom-built device. Strength at the elbow (isometric), grip strength and upper limb function (Action Research Arm test) were also assessed.TreatmentInjections of botulinum toxin type A (Botox) to the m.biceps brachii (mean dose 70 U), m.brachioradialis (mean dose 56.5 U) and m.flexor digitorum longus (mean dose 83.3 U).ResultsFollowing treatment, spasticity (as measured by flexor EMG activity) reduced but the MAS was unable to detect this improvement. In some subjects, isometric flexor strength at the elbow as well as grip strength increased. This was contrary to the expected weakening following treatment with botulinum toxin type A and suggests an optimization of motor control.ConclusionTreatment with Botox reduces spasticity but does not necessarily cause a reduction in the force generating capabilities at the joint. The improvement in strength may have contributed to the improvements in upper limb function. The MAS is an inappropriate measure of spasticity.

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