Effect of baseline spastic hemiparesis on recovery of upper-limb function following botulinum toxin type A injections and postinjection therapy.
OBJECTIVE
To determine whether baseline hand spastic hemiparesis assessed by the Chedoke-McMaster Assessment influences functional improvement after botulinum toxin type A (BTX-A) injections and postinjection therapy.


METHODS
Prospective cohort study.


METHODS
Outpatient spasticity clinic.


METHODS
Participants (N=14) with spastic hemiparesis divided into 2 groups: Chedoke-McMaster Assessment Hand-Higher Function (stage> or =4, n=5) and Chedoke-McMaster Assessment Hand-Lower Function (stage=2 or 3, n=9).


METHODS
Upper-limb BTX-A injections followed by 6 weeks of postinjection therapy.


METHODS
Primary outcomes were Motor Activity Log-28 and Motor Activity Log items. Secondary outcomes were Action Research Arm Test (ARAT), Motor Activity Log-Self-Report, and Modified Ashworth Scale (MAS). Measures were assessed at baseline (preinjection), 6 weeks, 9 weeks, and 12 weeks postinjection.


RESULTS
Primary and secondary outcomes improved significantly over time in both groups. Although no significant differences in ARAT or MAS change scores were noted between groups, Chedoke-McMaster Assessment Hand-Higher Function group demonstrated greater change on Motor Activity Log-28 (P=.013) from baseline to 6 weeks and Motor Activity Log items (P=.006) from baseline to 12 weeks compared to Chedoke-McMaster Assessment Hand-Lower Function group.


CONCLUSIONS
BTX-A injections and postinjection therapy improved hand function and reduced spasticity for both Chedoke-McMaster Assessment Hand-Higher Function and Chedoke-McMaster Assessment Hand-Lower Function groups. Clinicians should expect to see larger gains for persons with less baseline impairment.
Chang
Chia-Lin
CL
Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Munin
Michael C
MC
Skidmore
Elizabeth R
ER
Niyonkuru
Christian
C
Huber
Lynne M
LM
Weber
Douglas J
DJ
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D006225:Hand; D006801:Humans; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010291:Paresis / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020127:Recovery of Function; D020521:Stroke / Q000150:complications; D034941:Upper Extremity / Q000503:physiopathology*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A