The Effects of Botulinum Toxin Injections on Function in Patients with Spasticity

Spasticity can be one of the most challenging problems for patients with neurologic conditions such as cerebral palsy, spinal cord injuries, cerebrovascular accidents, multiple sclerosis, traumatic brain injuries, etc. It can lead to a wide variety of problems including decreased mobility, decreased quality of movement, interference with normal postural reactions, interference with functional activities, and pressure sores. Therefore, the medical community has focused on effective treatments for spasticity which do not produce overwhelming weakness, spasticity, paralysis, fatigue, and/or muscle atrophy. Since the late 1970\u27s, the use of botulinum toxin (BTX-A) injections to decrease spasticity has been investigated. The purpose of this paper is to review research studies involving the use of BTX-A injections for the management of spasticity arising from central nervous system dysfunction. This review will focus specifically on: (1) the effectiveness of BTX-A in decreasing spasticity, and (2) improvements in functional performance and quality of life due to this decrease in spasticity (including increased mobility, increased quality of movement, and increased independence in activities of daily living). In the majority of studies reviewed, significant decreases in spasticity upon injection of BTX-A were reported. These decreases in spasticity caused subsequent increases in active and passive range of motion, and decreases in pain and uncontrolled movements. Improvements in ambulation, transfer skills, hygiene skills, positioning ease, and overall function were less frequently examined, but reported in approximately half of the studies reviewed. Few studies mentioned the changes in quality of life or the increased ability in carrying out role functions in daily life following BTX-A injections. Additional research studies are needed to quantify the effects of BTX-A injections on functional limitations and on quality of life. If research shows that patients obtain improved function following BTXA injections, physical therapy may be paramount in helping clients recognize their newly found skills. The role of physical therapy following BTX-A injections is an area that warrants additional research