Dynamic splinting after treatment with botulinum toxin type-A: a randomized controlled pilot study.
BACKGROUND
Over 1.5 million Americans are diagnosed with a stroke each year, and excessive flexion or extension (hypertonia) of upper extremity joints are common secondary conditions. The purpose of this study was to compare the efficacy of botulinum toxin type-A and manual therapy, with the adjunct treatment of dynamic splinting on range of motion, spasticity, and elbow flexor hypertonia, in a randomized trial.


METHODS
Thirty-six subjects were recruited for this pilot study and all exhibited hypertonia in elbow flexion. Six patients were excluded due to noncompliance. Testing was done with pre/post active range of motion in elbow extension, and the Modified Ashworth Scale (extension) for spasticity. All patients received the current standard of care: botulinum toxin type-A injections and manual therapy. Experimental patients were randomly assigned adjunct treatment with Elbow Extension Dynasplint.


RESULTS
Thirty patients completed the study (mean age [SD] 52+/-17 years). The percentage of change in active range of motion in elbow extension was greater for the experimental than for control subjects (33.5% vs. 18.7%). The Modified Ashworth Scale (extension) scores showed comparable changes of a mean 9.3% improvement for experimental versus 8.6% for the control subjects.


CONCLUSIONS
This study confirmed the efficacy of botulinum toxin type-A in tone management and occupational therapy in contracture reduction. It also showed the value of dynamic splinting in maintaining gains in range of motion.
Lai
Jenny M
JM
Methodist Rehabilitation Associates, Houston, Texas, USA.
Francisco
Gerard E
GE
Willis
F Buck
FB
D000704:Analysis of Variance; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004551:Elbow Joint; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009122:Muscle Hypertonia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D009788:Occupational Therapy / Q000379:methods; D010349:Patient Compliance; D010865:Pilot Projects; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D013165:Splints; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A