• Chia-Lin Chang, Michael C Munin, Elizabeth R Skidmore, Christian Niyonkuru, Lynne M Huber, and Douglas J Weber.
• Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA.
• Arch Phys Med Rehabil. 2009 Sep 1; 90 (9): 1462-8.

ObjectiveTo 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.DesignProspective cohort study.SettingOutpatient spasticity clinic.ParticipantsParticipants (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).InterventionsUpper-limb BTX-A injections followed by 6 weeks of postinjection therapy.Main Outcome MeasuresPrimary 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.ResultsPrimary 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.ConclusionsBTX-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.

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