Effect of treating elbow flexor spasticity with botulinum toxin injection and adjunctive casting on hemiparetic gait parameters: A prospective case series

Objective: To investigate changes in hemiparetic gait parameters after treatment of elbow flexor spasticity with botulinum neurotoxin (BoNT) injection and adjunctive casting. Design: Prospective case series. Subjects: Ten participants with spasticity secondary to acquired brain injury (8 stroke, 2 traumatic brain injury). Interventions: Participants received BoNT injections for their spastic elbow flexors under ultrasound guid-ance. Two weeks post-injection, an elbow stretching cast was applied for 1 week. Outcome measures: Assessments using the Modified Ashworth Scale (MAS), Tardieu scale V1 angle of arrest at slow speed and V3 angle of catch at fast speed, 2-min walk test (2MWT), Edinburgh Gait Score scale (EGS) and video gait analysis for step-length symmetry were conducted pre-BoNT injection (t0) and at cast removal (t1). Goal attainment scale (GAS) was used to assess changes in spasticity and gait 3 months post-injection (t2). Results: At t1, participants showed a mean increase of 16.7° (p