A Study of Spasticity and Functional Outcomes after Phenol Intramuscular Motor Point Block in Neuropathic Patients

The Improvement of Spasticity and Functional Outcome of Phenol Intramuscular Motor Point Block in Patients with Spasticity


  • Kaewma A tel 0873028748


phenol block, spasticity, functional outcomes, Barthel index, rehabilitation



Objectives: This study was to investigate spasticity and functional outcomes of patient with spasticity after an intramuscular motor point block with phenol.

Setting: Rehabilitation Medicine Clinic, Nakornping Hospital.

Study design: Retrospective and analytic study.

Subjects: Neuropathic patients with spasticity who underwent an intramuscular motor point block with 5% phenol for treatment of spasticity from December 2016 to September 2018.

Methods: The modified Ashworth Scale (MAS) for severity of spasticity and the Barthel Index (BI) with maximum score 100 for functional outcomes before and after the intramuscular motor point block was extracted from patients’ medical records and analyzed by using paired t-test and generalized estimating equation (GEE). Complications after phenol block and patients’ opinions were also recorded and reviewed.

Results: There were 22 patients. Sixteen were diagnosed with stroke or brain lesion, 3 with spinal cord injury/lesion, and 3 with cerebral palsy. The total number of limbs treated was 71. When counting only the first time of phenol block (n=20), the MAS decreased (mean difference -1.5; 95%CI -1.8, -1.2; p=0.000) and the mean BI increased (mean difference 7.8; 3.1, 12.4; p=0.0024). When counting all treated limbs (n=71), the MAS decreased (GEE coefficient -1.4; 95%CI 1.6, -1.2; p=0.000) and the BI score increased (GEE coefficient 3.5; 95%CI 1.6, 5.5; p=0.000). Complications such as pain, limb swelling, and numbness were reported in 23.9% of the injected limbs. However, all symptoms resolved within a week after treatments.

Conclusion: An intramuscular motor point block with 5% Phenol could decrease spasticity and improve functional outcomes in neuropathic patients with spasticity.


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1. Suputtitada A. Spasticty. Bangkok: Ultraprinting Ltd; 2004.
2. Ghotbi N, Ansari NN, Naghdi S, Hasson S, Jamshidpour B, Amiri S. Inter-rater reliability of the modified Ashworth scale in assessing lower limb muscle spasticity. Brain Inj. 2009;23:815-9.
3. Mishra C, Ganesh GS. Inter-rater reliability of modified modified Ashworth scale in the assessment of plantar flexor muscle spasticity in patients with spinal cord injury. Physiother Res Int. 2014;19:231-7.
4. Akpinar P, Atici A, Ozkan FU, Aktas I, Kulcu DG, Sari A, et al. Reliability of the modified Aschworth scale and modified Tardieu scale in patients with spinal cord injuries. Spinal Cord. 2017;55:944-9.
5. Li F, Wu Y, Li X. Test-retest reliability and inter-rater reliability of the modified Tardieu scale and the modified Ashworth scale in hemiplegic patients with stroke. Eur J Phys Rehabil Med. 2014;50:9-15.
6. Meseguer-Henarejos AB, Sánchez-Meca J, López-Pina JA, Carles-Hernández R. Inter- and intra-rater reliability of the modified Ashworth scale: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2018;54:576-90.
7. Duffy L, Gajree S, Langhorne P, Stott DJ, Quinn TJ. Reliability (inter-rater agreement) of the Barthel index for assessment of stroke survivors: systematic review and meta-analysis. Stroke. 2013;44:462-8.
8. Dajpratham P, Meenaphant R, Junthon P, Pianmanakij S, Jantharakasamjit S, Yuwan A. The inter-rater reliability of Barthel Index (Thai version) in stroke patients. J Thai Rehabil Med 2006; 16:1-9.
9. Yan X, Lan J, Liu Y, Miao J. Efficacy and safety of botulinum toxin type A in spasticity caused by spinal cord injury: A randomized, controlled trial. Med Sci Monit. 2018;24:8160-71.
10. Alessandro Clemenzi, Rita Formisano, Maria Matteis, Luciano Gallinacci, Giulio Cochi, Paola Savina, et al. Care management of spasticity with botulinum toxin-A in patients with severe acquired brain injury: A 1-year follow-up prospective study. Brain Inj. 2012; 26:979-83.
11. Dionyssiotis Y, Kiourtidis D, Karvouni A, Kaliontzoglou A, Kliafas I. Consequences of neurologic lesions assessed by Barthel Index after Botox® injection may be underestimated. Ther Clin Risk Manag. 2012;8:385-91.
12. The Ministry of Public Health. Medical rehabilitation services, medical cost and price list of medical equipment, assistive devices and developmental media for persons with disability B.E. 2552. Government Gazette. 2009;126:47-9.
13. The National Health Security Office. Management guide of universal health care scheme 2018. Bangkok: National Health Security Office; 2017.
14. Perotto AO. Anatomical guide for the electromyographer: the limbs and trunk. 5th ed. Springfield: Charles C Thomas Pub; 1995.
15. Khunphasee A, Khunadorn F. Treatment of spasticity by phenol intramuscular neurolysis at Pramongkutklao Hospital during 1991-1995. J Thai Rehabil Med.1998;7:108-14.
16. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206-7.
17. Wang M. Generalized estimating equations in longitudinal data analysis: a review and recent developments. Adv Stat. 2014; 2014:1-11.
18. Tunchavanit K, Khunphasee A, Khunadorn F. Phenol intramuscular neurolysis: long term study at Pramongkutklao Hospital. J Thai Rehabil Med. 2001;10:117-26.
19. Cianca J, Dy R, Chiou-Tan FY, John J, Taber KH. Torsional anatomy of the lower limb: the appearance of anatomy in hemispastic position. J Comput Assist Tomogr. 2018;42:982-5.
20. Faye Chiou-Tan, John Cianca, Joslyn John, Erin Furr-Stimming, Sindhu Pandit, Katherine H Taber. Procedure Oriented Torsional Anatomy of the Forearm for Spasticity Injection. J Comput Assist Tomogr. 2015;39:820-3.
21. Poonnark W. A retrospective study of ultrasound guided capsular hydrodilatation with a mixture of normal saline, lidocaine and triamcinolone injection in patient with adhesive capsulitis. J Thai Rehabil Med. 2019;29:30-4.
22. The Royal College of Physiatrists of Thailand. Residency training curriculum in rehabilitation medicine 2013 [Internet]. Bangkok: The Royal College of Physiatrists of Thailand; 2013 [cited 2019 Jan 30]. Available from: http://rehabmed.or.th/main/%E0%B8%AB%E0%B8%A5%E0%B8%B1%E0%B8%81%E0%B8%AA%E0%B8%B9%E0%B8%95%E0%B8%A3%E0%B8%81%E0%B8%B2%E0%B8%A3%E0%B8%9D%E0%B8%B6%E0%B8%81%E0%B8%AD%E0%B8%9A%E0%B8%A3%E0%B8%A1%E0%B9%81%E0%B8%9E%E0%B8%97%E0%B8%A2/
23. Buntragulpoontawaa M, O’Brien TE, Kovindha A. Influence of rehabilitation medicine residency training in performing chemodenervation in children with cerebral palsy in Thailand. J Med Assoc Thai. 2017;100:347-52.
24. The Royal College of Physiatrists of Thailand. Residency training curriculum in rehabilitation medicine 2018. Chiang Mai: Seangsilp Printing, 2019.
25. Tilson JK, Sullivan KJ, Cen SY, Rose DK, Koradia CH, Azen SP, et al. Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference. J Am Phys Ther Assoc. 2010;90:196-208.
26. Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil. 2007; 88:1314-9.
27. Rikli RE, Jones CJ. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. J Aging and Physical Activity. 1998;6:363-75.
28. Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentio A. Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke. 2001;32:1635-9.
29. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232-40.
30. Buntragulpoontawee M, Euawongyarti P, Wongpakaran T, Ashford S, Rattanamanee S, Khunachiva J. Preliminary evaluation of the reliability, validity and feasibility of the arm activity measure - Thai version (ArmA-TH) in cerebrovascular patients with upper limb hemiplegia. Health Qual Life Outcomes. 2018;16:141.