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PUBLISHED: Neurolytic Injection of Botulinum Toxin Type A and Phenol for Spasticity a Patient with Traumatic Brain Injury

Objective
To evaluate the effects of Botulinum Toxin Type A (BTX-A) and 7% Phenol injection in the management of spasticity in a patient with traumatic brain injury at the University Hospital of the West Indies (UHWI).

Method
This is a case report of a patient treated at the Physiatry clinic at UHWI and who had Physiotherapy/Occupational therapy at UHWI and Sir John Golding Rehabilitation Center. The patient was functional only at a wheelchair level and had increased flexion at the right elbow and wrist. He received BTX-A injection to his right elbow flexors and wrist flexors. He continued therapy and was seen for follow up at six (6) weeks, ten (10) weeks and then seven (7) months after the BTX-A injection. He thereafter received 7% phenol to the right flexor carpi radialis. Any change in range of motion (ROM) of the joints was measured using a goniometer and spasticity was assessed using the Modified Ashworth Scale (MAS).

Results
The patient had improvement in the ROM with right elbow extension from 130° to 160° at six (6) weeks, then to 170 ° at ten (10) weeks however at seven (7) months the ROM decreased to 130° despite continuing therapy. He was treated with 7% phenol injection to his right flexor carpi radialis and had improvement in ROM of elbow extension to 165°. Wrist extension range of motion improved from -10o to neutral at six (6) and ten (10) weeks but then decreased to -5o at seven (7) months, but overall showed a +5° improvement. Additionally, he had Berg Balance improvement from 3 to 15 and Barthel Index from 13 to 72, and subsequently was able to walk using a roll walker, with assistance, for the first time after his injury.

Conclusion
Botulinum Toxin Type A and 7% phenol were effective in treating this patient with spasticity secondary to traumatic brain injury. Keywords: Botulinum Toxin Type A, 7% Phenol Injection, Spasticity, Traumatic Brain Injury, Physical Medicine & Rehabilitation.

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