Effect of botulinum toxin type A, motor imagery and motor observation on motor function of hemiparetic upper limb after stroke.
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.
Santamato
Andrea
A
Department of Physical Medicine and Rehabilitation-'OORR Hospital', University of Foggia, Italy. a.santamato@unifg.it
Panza
Francesco
F
Filoni
Serena
S
Ranieri
Maurizio
M
Solfrizzi
Vincenzo
V
Frisardi
Vincenza
V
Dellomonaco
Annarita
A
Amoruso
Maria Teresa
MT
Amoruso
Loredana
L
Kehoe
Patrick G
PG
Megna
Marisa
M
Fiore
Pietro
P
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*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A