理解的对吗？

Indications and Contraindications to Botulinum Toxin Injections

Spastic muscles can contribute to pain directly as myalgia, or indirectly by altering biomechanics with associated musculoskeletal pain [1]. However, spasticity can be benefcial for function, and botulinum toxin-associated paralysis can lead to further dysfunction [1]; if there are concerns about functional sequelae of treatment, coordinate care with a physiatrist. Spasticity is part of an upper motor neuron syndrome and should be distinguished from other causes of increased muscle tone. In contrast to spasticity, dystonia involves involuntary muscle contractions in distinct patterns, often without a known upper motor neuron injury or lesion [6]. If the etiology of muscle hypertonicity is in question, diagnosis by either a physiatrist or neurologist prior to initiating treatment is recommended. Black Box Warnings for distant spread of toxin effect should be considered, especially in the context of respiratory impairment ([3–5], see Table 3). Contraindications include neuromuscular junction disease (e.g. myasthenia gravis) and infection at the injection site [3].

 肉毒毒素注射的适应证和禁忌证

肌肉痉挛可直接导致肌痛，或通过改变相关的生物力学间接导致肌肉骨骼疼痛[1]。然而，痉挛对功能可能有益，肉毒毒素相关麻痹可能导致进一步功能障碍[1]，若担心治疗的功能性后遗症，请理疗师协助治疗。上运动神经元综合征均会痉挛，需据此识别上运动神经元综合征，并与其他增加肌张力的病因鉴别。与痉挛不同，肌张力障碍涉及不同模式下的肌肉不自主收缩，通常无已知的上运动神经元损伤或病变[6]。若怀疑肌张力过高的病因，建议理疗师或神经科医生诊断后再开始治疗。应警惕毒素远处扩散效应的黑框警告，尤其当呼吸受损时（[3-5]，见表3）。肉毒毒素注射的禁忌证包括神经肌肉接头疾病（如重症肌无力）和注射部位感染[3]。