Stroke Research Today is a free monthly online journal that collates and summarizes the latest research about Stroke, including details on treatment, recovery, rehabilitation, signs, symptoms. | ||||||||
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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.Sun SF, Hsu CW, Hwang CW, Hsu PT, Wang JL, Yang CL Department of Physical Medicine and Rehabilitation, Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan. sfsun.tw@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. Published 2 October 2006 in Phys Ther, 86(10): 1387-97.
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