Botulinum toxin type-A (BoNTA) and dynamic wrist-hand orthoses versus orthoses alone for the treatment of spastic-paretic upper extremity in chronic stroke patients

Abstract

Purpose: The purpose of this study was to in-vestigate the potential functional improvement of the spastic-paretic upper extremity of indi-viduals with chronic hemiparesis when using a dynamic wrist-hand orthosis with and without concurrent botulinum toxin type-A (BoNTA) in-jections into the spastic upper extremity mus-cles. Methods: A three-year retrospective chart review was conducted on all stroke patients re-ferred to out-patient occupational therapy for an upper extremity rehabilitation program, which included use of a dynamic wrist-hand orthosis (DWHO). Three charts documented concurrent treatment with a DWHO + BoNTA. Eleven charts documented DWHO use without concurrent BoNTA treatment. Pre-and post-intervention outcome measure scores were compared be-tween the two groups. Pre-and post-interven-tion scores were also analyzed irrespective of treatment group. Results: Although improve-ment approached significance on three of the documented outcome measures when compar-ing the DWHO + BoNTA and DWHO groups, no statistically significant changes were found. A significant difference (p < 0.05) however, was found between the pre-and post-intervention scores irrespective of treatment group in 13 of 14 of the outcome measures documented. Con-clusions: Further research with a larger sample size is suggested to assess the combined effect of using a dynamic wrist-hand orthosis and BoNTA injections into the spastic upper extrem-ity muscles of individuals with chronic hemi-paresis post stroke.