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Application of Combined Botulinum Toxin Type A and Modified Constraint-Induced Movement Therapy for an Individual With Chronic Upper-Extremity Spasticity After Stroke

SF Sun, MD, is affiliated with the Department of Physical Medicine and Rehabilitation, Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan
CW Hsu, MD, is affiliated with the Department of Internal Medicine, Veterans General Hospital
CW Hwang, MD, is affiliated with the Department of Physical Medicine and Rehabilitation, Veterans General Hospital
PT Hsu, MD, is affiliated with the Department of Physical Medicine and Rehabilitation, Veterans General Hospital
JL Wang, MD, is Director, Department of Physical Medicine and Rehabilitation, Veterans General Hospital
CL Yang, OT, is affiliated with the Department of Physical Medicine and Rehabilitation, Veterans General Hospital

Address all correspondence to Dr Sun at: sfsun.tw{at}yahoo.com.tw

Background and Purpose. Constraint-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 Description. The 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. Outcomes. The 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. Discussion. In 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.

Key Words: Botulinum toxin • Constraint-induced movement therapy • Spasticity • Stroke

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This article has been cited by other articles:

				S.-F. Sun, C.-W. Hsu, H.-P. Sun, C.-W. Hwang, C.-L. Yang, and J.-L. Wang Combined Botulinum Toxin Type A With Modified Constraint-Induced Movement Therapy for Chronic Stroke Patients With Upper Extremity Spasticity: A Randomized Controlled Study Neurorehabil Neural Repair, January 1, 2010; 24(1): 34 - 41. [Abstract] [PDF]