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, 04/11/2012  Clinical Article

Wolf SL et al. – 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).