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

Archives of Physical Medicine and Rehabilitation, 04/12/2012

Among chronic stroke survivors, botulinum toxin type A (BTX–A) did not impact function, movement, or tone more than a standardized exercise program.


  • A convenience sample of patients (N=25, age range, 23–76y) who sustained a stroke 3 to 24 months previously but could initiate wrist extension.
  • Participants were randomly selected to receive either BTX-A (maximum 300U) or saline, followed by 12 to 16 exercise sessions.
  • 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).


  • 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).

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