Physical therapy for an adult with chronic stroke after botulinum toxin injection for spasticity: a case report.
OBJECTIVE
In this case report, we describe the type and duration of a physical therapy and botulinum toxin type A (BoNTA) intervention directed at lower limb spasticity and the gait and balance improvement in a patient post-stroke. Treatment of focal spasticity with BoNTA intramuscular injections combined with physical therapy is recommended by rehabilitation experts. However, the optimal type and duration of physical therapy intervention to optimize any functional gains that follow chemodenervation induced by BoNTA has not been established.


METHODS
One individual with chronic stroke who received BoNTA injections for upper and lower extremity spasticity was included. Physical therapy intervention consisted of 45- to 60-min sessions twice weekly for 12 weeks, based on the Bobath-neurodevelopmental therapy approach, and an activity-based home program.


RESULTS
After BoNTA injections and physical therapy, the patient made clinically significant improvements in balance and gait speed and became more independent with his ambulation.


CONCLUSIONS
This case report demonstrates that physical therapy after BoNTA injections can result in significant functional improvements for individuals with spasticity after chronic stroke that may not be possible with BoNTA injections alone.
West Park Healthcare Centre ; Department of Physical Therapy.
Shannon
S
Gallagher
West Park Healthcare Centre ; Department of Physical Therapy ; Faculty of Health, York University, Toronto.
Chetan P
CP
Phadke
West Park Healthcare Centre ; Division of Physiatry, University of Toronto.
Farooq
F
Ismail
West Park Healthcare Centre ; Division of Physiatry, University of Toronto.
Chris
C
Boulias
botulinum toxins; muscle spasticity; stroke