OJTR  Vol.2 No.1 , February 2014
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
Purpose: The purpose of this study was to investigate the potential functional improvement of the spastic-paretic upper extremity of individuals with chronic hemiparesis when using a dynamic wrist-hand orthosis with and without concurrent botulinum toxin type-A (BoNTA) injections into the spastic upper extremity muscles. Methods: A three-year retrospective chart review was conducted on all stroke patients referred 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 between the two groups. Pre- and post-interven- tion scores were also analyzed irrespective of treatment group. Results: Although improvement approached significance on three of the documented outcome measures when comparing 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. Conclusions: 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 extremity muscles of individuals with chronic hemiparesis post stroke.

Cite this paper
Pooyania, S. and Semenko, B. (2014) 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. Open Journal of Therapy and Rehabilitation, 2, 12-18. doi: 10.4236/ojtr.2014.21003.
[1]   Evidence based review of stroke rehabilitation. (2013). http://www.ebrsr.com/reviews_details.php?Clinical-Consequences-of-Stroke-13

[2]   Van Peppen, R.P.S., Kwakkel, G., Wood-Dauphinee, S., Hendriks, H.J.M., Van der Wees, P.J. and Dekker, J. (2004) The impact of physical therapy on functional outcomes after stroke: What’s the evidence? Clinical Rehabili-tation, 18, 833-862. http://dx.doi.org/10.1191/0269215504cr843oa

[3]   Oujamaa, L., Relave, I., Froger, J., Mottet, D. and Pelissier, J. (2009) Rehabilitation of arm function after stroke. Literature review. Annals of Physical and Rehabil Medicine, 52, 269-293. http://dx.doi.org/10.1016/j.rehab.2008.10.003

[4]   Thielman, G.T., Dean, C.M. and Gentile, A.M. (2004) Rehabilitation of reaching after stroke: Task-related training versus progressive resistive exercise. Archives of Physical Medicine and Rehabilitation, 10, 1613-1618. http://dx.doi.org/10.1016/j.apmr.2004.01.028

[5]   Greenwood, R.J., Barnes, M.P., McMillan, T.M. and Ward, C.D. (2003) Handbook of neurological rehabilitation. 2nd Edition, Psychology Press, New York.

[6]   Hallett, M. (2001) Plasticity of the human motor cortex and recovery from stroke. Brain Research Reviews, 36, 169-174. http://dx.doi.org/10.1016/S0165-0173(01)00092-3

[7]   Nelles, G., Jentzen, W., Jueptner, M., Muller, S. and Diener, H.C. (2001) Arm training induced brain plasticity in stroke studied with serial positron emission tomography. NeuroImage, 13, 1146-1154. http://dx.doi.org/10.1006/nimg.2001.0757

[8]   Classen, J., Liepert, J., Wise, S.P., Hallett, M. and Cohen, L.G. (1998) Rapid plasticity of human cortical movement representation induced by practice. Journal of Neurophysiology, 79, 1117-1123.

[9]   Westlake, K. and Byl, N. (2013) Neural plasticity and implications for hand rehabilitation after neurological insult. Journal of Hand Therapy, 26, 87-92. http://dx.doi.org/10.1016/j.jht.2012.12.009

[10]   Lindsay, M.P., Gubitz, G. and Bayley, M. (2010) Canadian best practice recommendations for stroke care. Canadian Stroke Strategy Best Practices and Standards Writing Group, Ottawa.

[11]   Wolf, S.L., Winstein, C.J., Miller, J.P., Taub, E., Uswatte, G., Morris, D., et al. (2006) Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: The EXCITE randomized clinical trial. JAMA, 296, 2095-2104. http://dx.doi.org/10.1001/jama.296.17.2095

[12]   Shi, Y.X., Tian, J.H., Yang, K.E. and Zhao, Y. (2011) Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: A systematic review and metaanalysis. Archives of Physical Medicine and Rehabilitation, 92, 972-982. http://dx.doi.org/10.1016/j.apmr.2010.12.036

[13]   Taub, E., Uswatte, G., Bowman, M., Mark, V., Delgado, A., Bryson, C., et al. (2013) Constraint-induced movement therapy combined with chronic stroke patients with plegic hands: A case series. Archives of Physical Medicine and Rehabilitation, 94, 86-94. http://dx.doi.org/10.1016/j.apmr.2012.07.029

[14]   Taub, E., Uswatte, G., King, D.K., Morris, D., Crage, J.E. and Chatterjee, A. (2006) A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke, 37, 1045-1049. http://dx.doi.org/10.1161/01.STR.0000206463.66461.97

[15]   Page, S.J., Levine, P. and Leonard, A.C. (2005) Modified constraint-induced therapy in acute stroke: A randomized controlled pilot study. Neurorehabilitation and Neural Repair, 19, 27-32. http://dx.doi.org/10.1177/1545968304272701

[16]   Rowe, T., Blanton, S. and Wolf, S. (2009) Long-term follow-up after constraint-induced therapy: A case report of a chronic stroke survivor. AJOT, 63, 317-322.

[17]   Parker, V.M., Wade, D.T. and Langton-Hewer, R. (1986) Loss of arm function after stroke: Measurement, frequency, and recovery. International Rehabilitation Medicine, 8, 69-73.

[18]   Nichols-Larsen, D., Clark, P.C., Zeringue, A., Greenspan, A. and Blanton, S. (2005) Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke, 36, 1480-1484. http://dx.doi.org/10.1161/01.STR.0000170706.13595.4f

[19]   Barry, J.G., Ross, S.A. and Woehrle, J. (2012) Therapy incorporating a dynamic wrist-hand orthosis versus manual assistance in chronic stroke: A pilot study. Journal of Neurologic Physical Therapy, 36, 17-24. http://dx.doi.org/10.1097/NPT.0b013e318246203e

[20]   Sun, S.F., Hsu, C.W., Hwang, C.W., Hsu, P.T., Wang, J.L. and Yang, C.L. (2006) Application of combined botulinum toxin type A and modified constraint-induced movement therapy for an individual with chronic upper-extremity spasticity after stroke. Physical Therapy, 86, 1387-1397. http://dx.doi.org/10.2522/ptj.20050262

[21]   Butler, A., Blanton, S., Rowe, V. and Wolf, S. (2006) Attempting to improve function and quality of life using the FTM protocol: Case report. Journal of Neurologic Physical Therapy, 30, 148-156.

[22]   Hoffman, H. and Blakey, G. (2011) New design of dynamic orthoses for neurological conditions. Neuro Rehabilitation, 28, 55-61. http://dx.doi.org/10.3233/NRE-2011-0632

[23]   Jeon, H., Woo, Y., Yi, C., Kwon, O. Jung, M., Young-hee, L., et al. (2012) Effect of intensive training with a spring-assisted hand orthosis on movement smoothness in upper extremity following stroke: A pilot clinical trial. Topics in Stroke Rehabilitation 19, 320-328. http://dx.doi.org/10.1310/tsr1904-320

[24]   Broeks, J.G., Lankhorst, G.J., Rumping, K. and Prevo, A.J. (1999) The long-term outcome of arm function after stroke: Results of a follow-up study. Disability and Rehabilitation, 21, 357-364. http://dx.doi.org/10.1080/096382899297459

[25]   Evidence based research in stroke rehabilitation. (2013). http://www.ebrsr.com/~ebrsr/uploads/C_Motor_Recovery_(PR).pdf

[26]   Wissel, J., Ward, A.B., Erztgaard, P., Bensmail, D., Hecht, M.J., Lejeune, T.M., et al. (2009) European consensus table on the use of botulinum toxin type A in adult spasticity. Journal of Rehabilitation Medicine, 41, 13-25. http://dx.doi.org/10.2340/16501977-0303

[27]   Naumann, M., So, Y., Argoff, C.E., Childers, M.K., Dykstra, D.D., Gronseth, G.S., et al. (2008) Assessment: botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence based review): Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology, 70, 1707-1714. http://dx.doi.org/10.1212/01.wnl.0000311390.87642.d8

[28]   Teasell, R., Foley, N., Pereira, S., Sequeira, K. and Miller, T. (2012) Evidence to practice: Botulinum toxin in the treatment of spasticity post stroke. Topics in Stroke Rehabilitation, 19, 115-121. http://dx.doi.org/10.1310/tsr1902-115

[29]   Wolf, S., Milton, B., Reiss, A., Easley, K., Shenvi, N. and Clark, P. (2012) 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. Archives of Physical Medicine and Rehabilitation, 93, 578- 587. http://dx.doi.org/10.1016/j.apmr.2011.10.026

[30]   Sun, S.F., Hsu, C.W., Sun, H.P., Hwang, C.W., Yang, C.L. and Wang, J.L. (2010) Combined botulinum toxin type A with modified constraint-induced movement therapy for chronic stroke patients with upper extremity spasticity: A randomized controlled study. Neurorehabilitation and Neural Repair, 24, 34-41. http://dx.doi.org/10.1177/1545968309341060

[31]   Marciniak, C. (2011) Poststrokehypertonicity: Upper limb assessment and treatment. Topics in Stroke Rehabilitation, 18, 179-194. http://dx.doi.org/10.1310/tsr1803-179

[32]   Sheean, G., Lannin, N.A., Turner-Stokes, L., Rawicki, B. and Snow, B.J. (2010) Botulinum toxin assessment, intervention and after-care for upper limb hypertonicity in adults: International consensus statement. European Journal of Neurology, 17, 74-93. http://dx.doi.org/10.1111/j.1468-1331.2010.03129.x