Further assessment to determine the additive effect of botulinum toxin type A on an upper extremity exercise program to enhance function among individuals with chronic stroke but extensor capability.
OBJECTIVE
To determine whether dose-specified botulinum toxin type A (BTX-A) and a standardized exercise protocol produce better upper extremity function than placebo and the same exercise program.


METHODS
Double-blind randomized trial.


METHODS
A rehabilitation research center.


METHODS
A convenience sample of patients (N=25, age range, 23-76 y) who sustained a stroke 3 to 24 months previously but could initiate wrist extension.


METHODS
Participants were randomly selected to receive either BTX-A (maximum 300 U) or saline, followed by 12 to 16 exercise sessions.


METHODS
The primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcome measures included the Modified Ashworth Scale (MAS), active range of motion, and the Stroke Impact Scale (SIS; quality of life).


RESULTS
There were no group-by-time interactions for changes in the WMFT and no treatment difference (P=.86), although the BTX-A group could complete more tasks governing proximal joint motions. MAS scores improved for the BTX-A group and worsened for the control group after injection (P=.02), as did the SIS emotion domain (P=.035).


CONCLUSIONS
Among chronic stroke survivors, BTX-A did not impact function, movement, or tone more than a standardized exercise program.
Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA. swolf@emory.edu
Steven L
SL
Wolf
S Byron
SB
Milton
Aimee
A
Reiss
Kirk A
KA
Easley
Neeta V
NV
Shenvi
Patricia C
PC
Clark
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology* / Q000534:rehabilitation*; D053580:Muscle Strength / Q000502:physiology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000503:physiopathology*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A