title: Modified constraint-induced therapy and botulinum toxin A: a promising combination.
abstract: Modified constraint-induced therapy and chemodenervation with botulinum toxin A are each efficacious in managing stroke-induced motor disorders; however, the application of these two promising modalities in combination is yet to be examined. This case study describes a 44-yr-old man who experienced a right middle cerebral artery infarct 14 mo before participating in modified constraint-induced therapy. After modified constraint-induced therapy completion, the patient exhibited substantial improvement in affected upper limb use and function but retained difficulty with finger extension secondary to hypertonicity and spasticity in the forearm flexor muscles. Selective chemodenervation of these muscles with botulinum toxin A greatly improved the patient's self-reported hand function and his scores using objective measures. The authors of this paper present this case to raise the idea of increasing treatment efficacy by combining these two modalities.
authors.affiliation: Kessler Medical Rehabilitation Research and Education Corportation, West Orang, New Jersey, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Page
authors.forename: Elie
authors.initials: E
authors.lastname: Elovic
authors.forename: Peter
authors.initials: P
authors.lastname: Levine
authors.forename: Sue Ann
authors.initials: SA
authors.lastname: Sisto
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001132:Arm / Q000503:physiopathology*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy; D018737:Hand Strength; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000175:diagnosis; D007273:Injections, Intramuscular; D008297:Male; D009048:Motor Skills; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012149:Restraint, Physical / Q000379:methods*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A