Renee Gill APAM is a hospital-based physiotherapist from Epworth HealthCare who has worked for the past nine years in rehabilitation for neurological conditions such as stroke, Parkinson’s disease, multiple sclerosis and traumatic brain injury. 

She is currently completing her PhD, of which her PRF Seeding Grant study is one part, through the University of Melbourne. 

‘As a clinician working in a spasticity clinic, I wanted to find out whether botulinum toxin injections induce muscle weakness or not and what impact this has on active function. 

'The question would often arise – does this cause any weakness in the muscle that we’re injecting? – so there was always a cloud of doubt in the room as to whether we should or shouldn’t inject and this prompted me to investigate further. 

‘People with upper motor neuron lesions develop spasticity so they might be in a flexed position and the botulinum toxin aims to reduce the muscle activity and to relax the muscle. 

'It can help people in their limbs and not just their face so it’s very commonly used following stroke, traumatic brain injury or multiple sclerosis. 

'We advise people that there may be a side effect of weakness after the injection but that hasn’t been rigorously found through research and it needs to be formally investigated.’ 

Muscle weakness will be measured using a handheld dynamometer, before and after the injection, at three time points – within two weeks, 12 weeks and six months. 

Approximately 140–160 participants will be recruited from spasticity clinics around Victoria, with around 20 participants per commonly injected muscle, such as the brachioradialis and gastrocnemius. 

Data on functional outcomes will also be collected to examine the relationship between strength change and active function outcomes – such as the 10-metrewalk or six-minute-walk test, obtained as usual care within the clinic. 

‘The research will help us to gain some clarity. 

'Even if the botulinum injection does cause a bit of weakness, does that actually matter for the patient’s functional gain, which is probably the more important thing? 

'The active phase of the injection is around three months so usually patients are followed up at that point to see if they need a further injection. 

‘The clinical implications include allowing us greater understanding of what the injection does to the muscle itself – does it cause weakness or does it actually allow more strength to be obtained because the muscle can work more normally? 

'It will also help clinicians in their clinical reasoning as to who may or may not be appropriate for injection. 

'We’ve developed a formal neurological strength-testing protocol to outline a standardised testing procedure for commonly injected muscles (and their opposing muscles), which will be published as a manual and on a website that clinicians could use to standardise in their own spasticity clinic or practice.’ 

The PRF Seeding Grant will help Renee to fund the data collection phase, predominantly funding her time to complete the testing in the clinics, with a two-year timeframe for completion, which wouldn’t have been possible without the grant. 

‘I was blown away, honestly, when I found out I was successful. This work is very important to our patients. We put a lot of effort into the application so it’s a real honour to receive a PRF grant. I’m very grateful for the support from the APA.’