Objective: This retrospective study aimed to assess the effect of Botulinum toxin A (BoNT-A) injections in the lower limbs of hemiparetic patients on gait parameters, and to explore the relationship between improvements in clinical assessments and kinematic / spatiotemporal parameters assessed by gait analysis.

Background: BoNT-A is an effective treatment for spasticity. Apart from improving muscle tonus and range of motion in specific joints, injections in the lower limbs of hemiparetic patients improved subjective scales and clinical assessments of walking speed. Data on the effect of BoNT-A on functional outcomes described by spatiotemporal parameters and kinematics are rare.

Method: Hemiparetic patients with focal spasticity, admitted at a neurorehabilitation clinic from 2018 to 2021, injected with BoNT-A in the lower limbs, and with two gait analysis available (the first near the date of injection and the second 10 or more days after the injection) were included in this retrospective analysis.

Results: Data of 3 women and 6 men, mean age 50 years, with hemiparesis (5 right, 4 left) were analyzed. In total, a mean of 261.1 mouse units ± 49.6 SD of BoNT-A was injected in the affected lower extremity. After the injection, the distance walked during the 4 minutes timed walk test (TWT) had significantly improved from in median 130m (quartiles: 110; 246) to 185m (102; 263) and the walking performance had significantly improved on a subjective scale (range 1 to 10) from 6 (6; 8) to 9 (7; 10). In the gait analysis, significant improvements were only found for the pre-swing phase of the affected leg, which decreased from 24.7% (19.8%; 31.2%) to 23.4% (19.9%; 28.1%). Improvements in the TWT were correlated with improvements in the cadence during gait analysis (Spearman rho [r_s] 0.790, p=0.011). Furthermore, it correlated with parameters of the first gait analysis: Persons with shorter double stance phase (r_s -0.678, p=0.045), longer single stance phase (r_s 0.728, p=0.026) and shorter loading response (r_s -0.845, p=0.004) on the affected side, as well as shorter stance phase (r_s -0.711, p=0.032) and shorter pre-swing phase (r_s -0.853, p=0.003) on the non-affected side improved more on the TWT.

Conclusion: Persons with more symmetrical kinematic gait measures before BoNT-A injections had the largest improvements in the TWT.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quantitative-gait-analysis-to-evaluate-changes-in-gait-pattern-after-botulinum-toxin-a-injection-by-hemiparesis/