Botulinum Toxin Injections and Electrical Stimulation for Spastic Paresis Improve Active Hand Function Following Stroke

Abstract

Botulinum toxin type A (BTX-A) injections improve muscle tone and range of motion (ROM) among stroke patients with upper limb spasticity. However, the efficacy of BTX-A injections for improving active function is unclear. We aimed to determine whether BTX-A injections with electrical stimulation (ES) of hand muscles could improve active hand function (AHF) among chronic stroke patients. Our open-label, pilot study included 15 chronic stroke patients. Two weeks after BTX-A injections into the finger and/or wrist flexors, ES of finger extensors was performed while wearing a wrist brace for 4 weeks (5 days per week; 30-min sessions). Various outcomes were assessed at baseline, immediately before BTX-A injections, and 2 and 6 weeks after BTX-A injections. After the intervention, we noted significant improvements in Box and Block test results, Action Research Arm Test results, the number of repeated finger flexions/extensions, which reflect AHF, and flexor spasticity. Moreover, significant improvements in active ROM of wrist extension values were accompanied by marginally significant changes in Medical Research Council wrist extensor and active ROM of wrist flexion values. In conclusion, BTX-A injections into the finger and/or wrist flexors followed by ES of finger extensors improve AHF among chronic stroke patients.

Keywords: botulinum toxin; electrical stimulation; hand; rehabilitation; spastic paresis; spasticity; stroke management.

Figure 1

Experimental design. Primary and secondary outcomes are assessed at baseline (week 1, T0), immediately before BTX-A injections (week 0, T1), and 2 weeks (week 2, T2) and 6 weeks (week 6, T3) after BTX-A injections, by an experienced research occupational therapist. Patients exhibiting changes in outcomes between T0 and T1 were excluded. BTX-A: botulinum toxin type A, ES: electrical stimulation.