title: Effect of botulinum toxin type A, motor imagery and motor observation on motor function of hemiparetic upper limb after stroke.
abstract: BACKGROUND
  In rehabilitation settings, motor imagery, motor observation and mirror therapy serve as techniques for the recovery of paretic upper limb in patients with movement disorders after stroke, whereas botulinum toxin type A (BTX-A) offers the best treatment for focal spasticity.
  
  
  METHODS
  After haemorrhagic stroke, three patients (two men and one woman, mean age: 61.2 +/- 7.03) presented with hemiparesis of the left or right hand and arm with flexion of fingers, wrist and elbow, with no disturbance to sensitivity but with loss of use handoff the limb to write, eat or dress. After BTX-A injections, the patients underwent a daily rehabilitation programme based on motor imagery and motor observation for 1 month. Before and after the combined treatment, the motor function, spasticity and functional deficits of the patient were extensively measured. After a 3-month follow-up, upper limb spasticity measured with the Modified Ashworth Scale had worsened, yet the associated score remained lower than that at baseline. However, in these three patients a large improvement of motor function of the hemiparetic upper limb was observed.
  
  
  CONCLUSIONS
  Combined treatment may be a viable rehabilitation option in post-stroke patients with disability to upper-extremity motor function, however further investigations are needed to determine its reproducibility in larger case series or clinical trials.
authors.affiliation: Department of Physical Medicine and Rehabilitation-'OORR Hospital', University of Foggia, Italy. a.santamato@unifg.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Santamato
authors.forename: Francesco
authors.initials: F
authors.lastname: Panza
authors.forename: Serena
authors.initials: S
authors.lastname: Filoni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ranieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Solfrizzi
authors.forename: Vincenza
authors.initials: V
authors.lastname: Frisardi
authors.forename: Annarita
authors.initials: A
authors.lastname: Dellomonaco
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Amoruso
authors.forename: Loredana
authors.initials: L
authors.lastname: Amoruso
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Kehoe
authors.forename: Marisa
authors.initials: M
authors.lastname: Megna
authors.forename: Pietro
authors.initials: P
authors.lastname: Fiore
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010291:Paresis / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A