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Original Article
 
Addition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: A pilot double-blind randomized trial
Hayley Scott1, Natasha A. Lannin2, Coralie English3, Louise Ada4 Tamina Levy5 Rhiannon Hart6 Maria Crotty7
1Bachelor of Health Science and Master of Occupational Therapy Practice with Honours, Occupational Therapist, Sunshine Hospital Melbourne Australia
2PhD, Associate Professor, College of Science, Health & Engineering, La Trobe University, Melbourne, Australia; and Occupational Therapy Department, Alfred Health, Melbourne, Australia
3Associate Professor, School of Health Sciences, Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Hunter Medical Research Institute, Australia
4Professor, Physiotherapy, School of Health Sciences, The University of Sydney, Australia
5BAppSc (Physiotherapy), Senior Physiotherapist, Repatriation General Hospital, Adelaide, Australia
6BAppSc (Occupational Therapy), Senior Occupational Therapist, Repatriation General Hospital, Adelaide, Australia
7Professor of Rehabilitation and Aged Care, Flinders University, Repatriation General Hospital, Adelaide, Australia

Article ID: 100028D05HS2017
doi:10.5348/D05-2017-28-OA-4

Address correspondence to:
Natasha Lannin
Occupational Therapy Department, Alfred Health
the Alfred, 55 Commercial Road, Prahran
Victoria, Australia

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How to cite this article
Scott H, Lannin NA, English C, Ada L, Levy T, Hart R, Crotty M. Addition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: A pilot double-blind randomized trial. Edorium J Disabil Rehabil 2017;3:30–35.


Abstract

Aims: Does the addition of botulinum toxin type A increase the effect of casting for improving wrist extension after stroke in people with upper limb spasticity?
Methods: Randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis which was part of a larger trial included 18 adults with upper limb spasticity two years after stroke (89%) or stroke-like conditions (11%). The experimental group (n=7) received botulinum toxin type A injections to upper limb muscles for spasticity management followed by two weeks of wrist casting into maximum extension. The control group (n=11) received two weeks of casting only. Range of motion (goniometry) measured at baseline and after two weeks of casting. Results: Passive wrist extension for the experimental group improved over two weeks from 22 degrees (SD 16) to 54 degrees (SD 16), while the control group improved from 21 degrees (SD 29) to 43 degrees (SD 26). The experimental group increased passive wrist extension 13 degrees (95% CI 4 to 31) more than the control group which was not statistically significant.
Conclusion: Joint range of motion improved over a two-week period for both groups. Botulinum toxin type A injection followed-by casting produced a mean, clinically greater range of motion than casting alone, therefore, a fully-powered trial is warranted.

Keywords: Contracture, Muscle spasticity, Rehabilitation, Serial casts, Stretch


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Author Contributions
Hayley Scott – Substantial contribution to design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be studied
Natasha A. Lannin – Substantial contribution to design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be studied
Coralie English – Substantial contribution to design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be studied
Lousie Ada – Substantial contribution to design, Adquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be studied
Tamina Levy – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be studied
Rhiannon Hart – Aquisition of data, Revising it critically for important intellectual content, Final approval of the version to be studied
Maria Crotty – Substantial contribution to design, Revising it critically for important intellectual content, Final approval of the version to be studied
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest
Copyright
© 2017 Hayley Scott et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.