Abstract
Spasticity and motor recovery are both related to neural plasticity after stroke. A balance of activity in the primary motor cortex (M1) in both hemispheres is essential for functional recovery. In this study, we assessed the intracortical inhibitory and facilitatory circuits in the contralesional M1 area in four patients with severe upper limb spasticity after chronic stroke and treated with botulinum toxin-A (BoNT-A) injection and 12 weeks of upper limb rehabilitation. There was little to no change in the level of spasticity post-injection, and only one participant experienced a small improvement in arm function. All reported improvements in quality of life. However, the levels of intracortical inhibition and facilitation in the contralesional hemisphere were different at baseline for all four participants, and there was no clear pattern in the response to the intervention. Further investigation is needed to understand how BoNT-A injections affect inhibitory and facilitatory circuits in the contralesional hemisphere, the severity of spasticity, and functional improvement.
Highlights
Spasticity and weakness are the primary motor impairments after stroke and impose significant challenges for treatment and patient care
There is considerable variability in the onset of spasticity, which may occur in the short, medium- or long-term after stroke (Ward, 2012), and the relationship between spasticity and motor recovery remains poorly understood by clinicians and researchers
The criteria for inclusion were unilateral stroke >2 years; age ≥ 18 years; severe unilateral upper limb paresis with a score of 3 or less on the Upper Arm Function and Hand Movements Subscales of the Motor Assessment Scale (MAS); assessed by a rehabilitation physician for potential to benefit from botulinum toxin-A (BoNT-A) injection to the upper limb for spasticity affecting motor control; no contraindications to BoNT-A injections; able to communicate and understand English; ability and willingness to participate in the study and provide informed consent
Summary
Spasticity and weakness (spastic paresis) are the primary motor impairments after stroke and impose significant challenges for treatment and patient care. Spasticity has downstream effects on the patient’s quality of life and places substantial burdens on the caregivers and society (Zorowitz et al, 2013). Spasticity and motor recovery are both related to neural plasticity after stroke. There is considerable variability in the onset of spasticity, which may occur in the short-, medium- or long-term after stroke (Ward, 2012), and the relationship between spasticity and motor recovery remains poorly understood by clinicians and researchers. Facilitation and modulation of neural plasticity through rehabilitative strategies, such as early intervention with repetitive goal-oriented intensive
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