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

Wolf SL, Milton SB, Reiss A, Easley KA, Shenvi NV, Clark PC. 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. Arch Phys Med Rehabil 2012;93:578-87. Objective: To determine whether dose-specified botulinum toxin type A (BTX-A) and a standardized exercise protocol produce better upper extremity function than placebo and the same exercise program. Design: Double-blind randomized trial. Setting: A rehabilitation research center. Participants: 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. Interventions: Participants were randomly selected to receive either BTX-A (maximum 300U) or saline, followed by 12 to 16 exercise sessions. Main Outcome Measures: 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). Results: 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). Conclusions: Among chronic stroke survivors, BTX-A did not impact function, movement, or tone more than a standardized exercise program.