Effect of Baseline Spastic Hemiparesis on Recovery of Upper-Limb Function Following Botulinum Toxin Type A Injections and Postinjection Therapy

Abstract 

Chang C-L, Munin MC, Skidmore ER, Niyonkuru C, Huber LM, Weber DJ. Effect of baseline spastic hemiparesis on recovery of upper-limb function following botulinum toxin type A injections and postinjection therapy.

Objective

To determine whether baseline hand spastic hemiparesis assessed by the Chedoke-McMaster Assessment influences functional improvement after botulinum toxin type A (BTX-A) injections and postinjection therapy.

Design

Prospective cohort study.

Setting

Outpatient spasticity clinic.

Participants

Participants (N=14) with spastic hemiparesis divided into 2 groups: Chedoke-McMaster Assessment Hand-Higher Function (stage≥4, n=5) and Chedoke-McMaster Assessment Hand-Lower Function (stage=2 or 3, n=9).

Interventions

Upper-limb BTX-A injections followed by 6 weeks of postinjection therapy.

Main Outcome Measures

Primary outcomes were Motor Activity Log-28 and Motor Activity Log items. Secondary outcomes were Action Research Arm Test (ARAT), Motor Activity Log-Self-Report, and Modified Ashworth Scale (MAS). Measures were assessed at baseline (preinjection), 6 weeks, 9 weeks, and 12 weeks postinjection.

Results

Primary and secondary outcomes improved significantly over time in both groups. Although no significant differences in ARAT or MAS change scores were noted between groups, Chedoke-McMaster Assessment Hand-Higher Function group demonstrated greater change on Motor Activity Log-28 (P=.013) from baseline to 6 weeks and Motor Activity Log items (P=.006) from baseline to 12 weeks compared to Chedoke-McMaster Assessment Hand-Lower Function group.

Conclusions

BTX-A injections and postinjection therapy improved hand function and reduced spasticity for both Chedoke-McMaster Assessment Hand-Higher Function and Chedoke-McMaster Assessment Hand-Lower Function groups. Clinicians should expect to see larger gains for persons with less baseline impairment.

Key Words: Botulinum toxin type A, Electric stimulation therapy, Muscle spasticity, Recovery of function, Rehabilitation, Stroke, Upper extremity

List of Abbreviations: ARAT, Action Research Arm Test, BTX-A, botulinum toxin type A, CMA, Chedoke-McMaster Assessment, FES, functional electrical stimulation, MAS, Modified Ashworth Scale