The Effect Of Botulinum Toxin Type A(BTXA) On Brunnstrom Stages Of Upper Limb After A Stroke

Objective : To investigate the effect of Botulinum toxin type A(BTXA)and rehabilitation on upper limb Brunnstrom stages and ADL(Activities of daily living) after a stroke. Methods : In a randomized controlled trial, 30 patients were allocated to either an experimental group (n=15) that received BTXA into muscles of the effected arm or to a controlled group (n=15). All patients Brunnstrom stage and MAS stage ≥ grade II . All were treated with rehabilitative methods. The intervention was applied for 3 months .All were evaluated for the severity of spasticity (Modified Ashworth Scale,MAS) ,the level of impairment (Brunnstrom assessment and Fugl-Meyer upper limb test) and disability(Functional Independence Measure, FIM) before treatment and after 1 week, 1, 2, 3 months. Results: Patients who received BTXA had significant reduction of muscle tone(P<0.01). Patients in the experimental group performed better on the Brunnstrom stages and Fugl-Meyer test at the end of 2 months (P<0.05). Results on FIM had no effect at the level of disability , but had greater improvement in self-care at the end of 2 months. There were no major adverse events associated with injection of BTXA. Conclusions: Intramuscular injection of BTXA is safe and useful in reducing spasticity of the arm and finger muscles. Combined with rehabilitation ,it can improve the patients' upper limb Brunnstrom stages, motor ability and self-care providing a new way in treating spasticity after a stroke.