• Physical therapy · Oct 2006

    Case Reports Clinical Trial

    Application of combined botulinum toxin type A and modified constraint-induced movement therapy for an individual with chronic upper-extremity spasticity after stroke.

    • Shu-Fen Sun, Chien-Wei Hsu, Chiao-Wen Hwang, Pei-Te Hsu, Jue-Long Wang, and Chia-Lin Yang.
    • Department of Physical Medicine and Rehabilitation, Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan. sfsun.tw@yahoo.com.tw
    • Phys Ther. 2006 Oct 1; 86 (10): 1387-97.

    Background And PurposeConstraint-induced movement therapy (CIMT) is a promising intervention for retraining upper-extremity function after a stroke. The purpose of this case report is to describe the use of a combination of botulinum toxin type A (BtxA) and a modified CIMT program for a patient with severe spasticity who was unable to use his right upper extremity.Case DescriptionThe 52-year-old patient, who had a stroke 4 years ago, did not meet the minimum motor criteria for CIMT benefit. After receiving BtxA injections targeting the elbow, wrist, and finger flexors, he completed a 4-week program of modified CIMT followed by a 5-month home exercise program.OutcomesThe patient exhibited improvement in muscle tone (the velocity-dependent resistance to stretch that muscle exhibits) and in scores on several upper-extremity function tests (Modified Ashworth Scale, Motor Activity Log, Wolf Motor Function Test, Action Research Arm Test, and Fugl-Meyer Assessment of Motor Recovery). He also reported making much progress in the functional use of the involved upper extremity.DiscussionIn a patient with severe flexor spasticity and nonuse of the dominant upper extremity after a stroke, a combined treatment of BtxA and modified CIMT may have resulted in improved upper-extremity use.

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