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Toxins 2017, 9(7), 216; doi:10.3390/toxins9070216

Rehabilitation plus OnabotulinumtoxinA Improves Motor Function over OnabotulinumtoxinA Alone in Post-Stroke Upper Limb Spasticity: A Single-Blind, Randomized Trial

1
Department of Neurology, 1542 Tulane Ave, Room 111B, New Orleans, LA 70112, USA
2
Department of Neurology, MSC10 5620, Health Sciences Center. 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
3
New Mexico VA Healthcare System, 1501 San Pedro SE, Albuquerque, New Mexico, NM 87108, USA
4
Department of Neurology, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston Salem, NC 27157, USA
5
VA Medical Center, 4150 Clement St, San Francisco, CA 94121, USA
*
Author to whom correspondence should be addressed.
Received: 24 February 2017 / Revised: 29 May 2017 / Accepted: 29 June 2017 / Published: 11 July 2017
(This article belongs to the Section Bacterial Toxins)
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Abstract

Background: OnabotulinumtoxinA (BoNT-A) can temporarily decrease spasticity following stroke, but whether there is an associated improvement in upper limb function is less clear. This study measured the benefit of adding weekly rehabilitation to a background of BoNT-A treatments for chronic upper limb spasticity following stroke. Methods: This was a multi-center clinical trial. Thirty-one patients with post-stroke upper limb spasticity were treated with BoNT-A. They were then randomly assigned to 24 weeks of weekly upper limb rehabilitation or no rehabilitation. They were injected up to two times, and followed for 24 weeks. The primary outcome was change in the Fugl–Meyer upper extremity score, which measures motor function, sensation, range of motion, coordination, and speed. Results: The ‘rehab’ group significantly improved on the Fugl–Meyer upper extremity score (Visit 1 = 60, Visit 5 = 67) while the ‘no rehab’ group did not improve (Visit 1 = 59, Visit 5 = 59; p = 0.006). This improvement was largely driven by the upper extremity “movement” subscale, which showed that the ‘rehab’ group was improving (Visit 1 = 33, Visit 5 = 37) while the ‘no rehab’ group remained virtually unchanged (Visit 1 = 34, Visit 5 = 33; p = 0.034). Conclusions: Following injection of BoNT-A, adding a program of rehabilitation improved motor recovery compared to an injected group with no rehabilitation. View Full-Text
Keywords: stroke; rehabilitation; onabotulinumtoxinA; occupational therapy; muscle spasticity; physical therapy stroke; rehabilitation; onabotulinumtoxinA; occupational therapy; muscle spasticity; physical therapy
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MDPI and ACS Style

Devier, D.; Harnar, J.; Lopez, L.; Brashear, A.; Graham, G. Rehabilitation plus OnabotulinumtoxinA Improves Motor Function over OnabotulinumtoxinA Alone in Post-Stroke Upper Limb Spasticity: A Single-Blind, Randomized Trial. Toxins 2017, 9, 216.

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