Variations of Tendon Tap Force Threshold needed to Evoke Surface Electromyogram Responses after Botulinum Toxin Injection in Chronic Stroke Survivors*

Chronic stroke survivors with spastic hemiplegia have various clinical presentations of ankle and foot muscle spasticity patterns. They are mechanical consequences of interactions between spasticity and weakness of surrounding muscles during walking. Four common ankle and foot spasticity patterns are described and discussed through sample cases. The patterns discussed are equinus, varus, equinovarus, and striatal toe deformities. Spasticity of the primary muscle(s) for each deformity is identified. However, it is emphasized that clinical presentation depends on the severity of spasticity and weakness of these muscles and their interactions. Careful and thorough clinical assessment of the ankle and foot deformities is needed to determine the primary cause of each deformity. An understanding of common ankle and foot spasticity patterns can help guide clinical assessment and selection of target spastic muscles for botulinum toxin injection or nerve block.

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Precise quantification of the time course of voluntary activation capacity following Botulinum toxin injections in the biceps brachii muscles of chronic stroke survivors

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-020-00716-z ◽

2020 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

S. Chandra ◽

B. Afsharipour ◽

W. Z. Rymer ◽

N. L. Suresh

Keyword(s):

Botulinum Toxin ◽

Time Course ◽

Biceps Brachii ◽

Chronic Stroke ◽

Voluntary Activation ◽

Stroke Survivors ◽

Precise Quantification ◽

Botulinum Toxin Injections ◽

Activation Capacity

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Ultrasonographic Evaluation of Botulinum Toxin Injection Site for the Medial Approach to Tibialis Posterior Muscle in Chronic Stroke Patients with Spastic Equinovarus Foot: An Observational Study

Toxins ◽

10.3390/toxins9110375 ◽

2017 ◽

Vol 9 (11) ◽

pp. 375 ◽

Cited By ~ 1

Author(s):

Alessandro Picelli ◽

Alessio Baricich ◽

Elena Chemello ◽

Nicola Smania ◽

Carlo Cisari ◽

...

Keyword(s):

Botulinum Toxin ◽

Injection Site ◽

Botulinum Toxin Injection ◽

Muscle Thickness ◽

Chronic Stroke ◽

Tibialis Posterior ◽

Anatomical Landmarks ◽

Echo Intensity ◽

Stroke Patients ◽

Medial Approach

The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: tibialis posterior muscle depth, thickness, and echo intensity. As to the spastic tibialis posterior, we found a mean muscle depth of 26.5 mm and a mean muscle thickness of 10.1 mm. Furthermore we observed a median tibialis posterior muscle echo intensity of 3.00 on the Heckmatt scale. The tibialis posterior muscle thickness was found to be inversely associated with its depth (p < 0.001) and echo intensity (p = 0.006). Furthermore, tibialis posterior muscle depth was found to be directly associated with its echo intensity (p = 0.004). Our findings may usefully inform manual needle placement into the tibialis posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.

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