Application of combined botulinum toxin type A and modified constraint-induced movement therapy for an individual with chronic upper-extremity spasticity after stroke.
OBJECTIVE
Constraint-induced movement therapy (CIMT) is a promising intervention for retraining upper-extremity function after a stroke. The purpose of this case report is to describe the use of a combination of botulinum toxin type A (BtxA) and a modified CIMT program for a patient with severe spasticity who was unable to use his right upper extremity.


METHODS
The 52-year-old patient, who had a stroke 4 years ago, did not meet the minimum motor criteria for CIMT benefit. After receiving BtxA injections targeting the elbow, wrist, and finger flexors, he completed a 4-week program of modified CIMT followed by a 5-month home exercise program.


RESULTS
The patient exhibited improvement in muscle tone (the velocity-dependent resistance to stretch that muscle exhibits) and in scores on several upper-extremity function tests (Modified Ashworth Scale, Motor Activity Log, Wolf Motor Function Test, Action Research Arm Test, and Fugl-Meyer Assessment of Motor Recovery). He also reported making much progress in the functional use of the involved upper extremity.


CONCLUSIONS
In a patient with severe flexor spasticity and nonuse of the dominant upper extremity after a stroke, a combined treatment of BtxA and modified CIMT may have resulted in improved upper-extremity use.
Sun
Shu-Fen
SF
Department of Physical Medicine and Rehabilitation, Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan. sfsun.tw@yahoo.com.tw
Hsu
Chien-Wei
CW
Hwang
Chiao-Wen
CW
Hsu
Pei-Te
PT
Wang
Jue-Long
JL
Yang
Chia-Lin
CL
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D026241:Exercise Movement Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000534:rehabilitation*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D034941:Upper Extremity
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A