Efficacy of combined botox a and modified constraint-induced movement therapy on function of upper limb in stroke patients

Abstract EN

Objective: The purpose of this study was to describe the use of a combination of botulinum toxin type A (Botox A) injections and a modified constraint-induced movement therapy (CIMT) for right sided hemiplegic patients with moderate to severe spasticity and unable to use their right upper extremity 3 – 6 months after the first ischemic stroke and to compare between the modified CIMT and usual physical therapy.

Methodology : Forty right handed patients with right.

sided hemi paresis were studied.

They were 26 males (65 %) and 14 females (35 %).

All patients were subjected to complete history taking including the duration of stroke, complete clinical and neurological examinations and all patients were given Botox A in at least three muscles with maximum dosage of 320 IU.

Then they were classified into two groups as regard the treatment protocols : Group 1: 20 patients treated with modified CIMT and Group 2: 20 patients treated with usual physical therapy.

Assessment was done at the base and after 4, 8 and 12 weeks.

Results : There was more significant improvement in spasticity of right upper limb in group (1) as assessed using the Modified Ashworth Scale (MAS).

Also, the Wolf Motor Functional Test (WMFT) timed-tasks for functional assessment improved than in group (2).

Conclusion : Botox A injection combined with a modified CIMT are more effective for stroke patients with post- moderate to severe spasticity and impaired functional ability in right upper limb than Botox A injection plus the usual physical therapy.