Three dimensional innervation zone imaging in spastic muscles of stroke survivors.

The outcome of botulinum toxin (BTX) therapy of post-stroke spasticity relies largely on accuracy of BTX injection to the proximity of innervation zones (IZs). Recently developed three-dimensional IZ imaging (3DIZI) is the only technique currently available to provide 3D distributions of IZs in vivo, yet its performance has not been validated under pathological conditions. The performance of 3DIZI was evaluated in the spastic biceps brachii muscles of four chronic stroke subjects. High-density surface electromyography (sEMG) and intramuscular electromyography (iEMG) were simultaneously recorded. The IZ location in the 3D space of the spastic biceps calculated using the 3DIZI technique from sEMG recordings were compared against the IZ location detected using intramuscular wires. 3DIZI successfully reconstructed the IZs in the 3D space of the spastic biceps of all four stroke subjects, with a localization error of 4.7  ±  2.7 mm, and specifically a depth error of 1.8  ±  0.4 mm. Results have demonstrated the robust performance of 3DIZI under pathological conditions, laying a solid foundation for clinical application of 3D source imaging in leading precise BTX injections for spasticity management.