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

Sepideh Pooyania,Brenda Semenko

doi:10.4236/ojtr.2014.21003

Abstract

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.

Highlights

IntroductionUpper extremity complications are common following stroke and may be seriously debilitating
Cerebrovascular disorders represent the third leading cause of mortality and the second major cause of long term disability in North America
A three year retrospective chart review was conducted on all stroke patients referred to out-patient occupational therapy (OT) for an upper extremity rehabilitation program, which included the use of a dynamic wrist-hand orthosis, i.e. SaeboFlexTM

Summary

Introduction

Upper extremity complications are common following stroke and may be seriously debilitating. For those upper extremities with signs of recovery, consensus opinion is that attempts to restore function through therapy should be made [1]. Task specific training has been shown to facilitate the recovery of upper extremity function [2,3,4,5,6] and to influence long term cortical reorganization [7,8]. Rehabilitation efforts that maximize the extent of cortical reorganization appear to demonstrate the greatest chance of achieving success in functional outcomes [9]. The Canadian Best Practice Recommendations for Stroke Care (2010) for Management of the Arm and Hand (Section 5.4.1) [10] state that therapy should consist of: “repetitive and intense use of novel tasks that challenge the patient to acquire necessary motor skills to use the involved limb during functional tasks and activities (Evidence Levels: Early—Level A, Late—Level A).” Constraint induced

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