Botulinum Toxin Effect on Voluntary and Stretch Reflex–Related Torque Produced by the Quadriceps

Abstract

BoNT A appeared to delay the stretch-reflex angle at peak torque, whereas the voluntary torque decreased. After strict patient selection, BoNT A injection into the RF muscle led to improvements in impairment, activity, and discomfort.

Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review

“…Bernuz et al 26 reported that 3/15 participants had subsequent hip flexion weakness after injection of rectus femoris, despite no weakness in the knee extensors. Whether the weakness affected walking ability was not reported, and there was no subanalysis for whether outcomes were worse for these affected individuals.…”

“…Most studies [26][27][28][29]31,33 also reported an improvement in functional outcome measures in the ICF activity domain. However, an improvement in MAS was not always associated with improvement in function; 8 of the 19 participants in the case series by Hecht et al 30 discontinued BoNT injections for this reason.…”

“…With time, collateral sprouting and regrowth of nerve endings will reverse the effects of BoNT. 9 The effects of BoNT on individuals with SCI were reported in three level 4 pre-post studies [26][27][28] and six level 5 studies (one retrospective chart review, 29 five case series/studies [30][31][32][33][34] ). Results from the included studies are summarized in Table 2.…”

“…There is level 4 and level 5 evidence, based on three pre-post studies, [26][27][28] one retrospective chart review 29 and five case series/ studies, [30][31][32][33][34] that BoNT has variable effects on lower limb spasticity in SCI. Generally, there were improvements in outcomes measures that looked at body structure and function (for example, MAS), as well as activities (for example, gait).…”

“…Nine studies investigated the use of BoNT, [26][27][28][29][30][31][32][33][34] and 10 studies investigated phenol/alcohol [35][36][37][38][39][40][41][42][43][44] for management of spasticity in SCI with chemodenervation. The literature search did not identify any randomized or non-RCTs looking at management of spasticity in a sample population with ⩾ 50% SCI participants, precluding the use of PEDro and Downs and Black Scale for quality assessment.…”