Abstract
BACKGROUND:Botulinum toxin injection (BTI) reduces muscle hyperactivity but its effect on active upper limb function is limited. Intensive rehabilitation could optimize the effects; however, outpatient post-stroke rehabilitation is usually not intensive. One solution could be self-rehabilitation. OBJECTIVES:The aim of this randomized controlled trial was to determine the effects of a self-rehabilitation program combined with BTI on upper limb function in individuals with chronic hemiparesis. METHODS:Thirty-three outpatients were randomly allocated to receive either BTI + self-rehabilitation (R group: n=17) or BTI alone (C group: n=16). Outcomes evaluated just before the BTI and 4 weeks later included: Wolf Motor Function Test (WMFT time – Primary Outcome), Action Research Arm Test, fatigue and quality of life. RESULTS:Change in WMFT was not different between groups at 4 weeks (WMFT time: -14% for R group, -4 % for C group. WFMT score: +12 % for R group, 0 % in C group). WFMT time and score improved significantly (-14 %, p=0.01 and +12 %, p=0.02 respectively) in the R group only. In addition, the proportion of patients with improved WMFT time and scores was higher in the R group (71% improved score, 77% improved time, C group 43% improved score, 50% improved time). Passive range of shoulder flexion (p=0.03) and wrist extension (p=0.01) also improved only in the R group. No other variables changed significantly. Compliance was excellent; average daily training time was greater than that prescribed. CONCLUSIONS:The addition of a self-rehabilitation program to BTI did not significantly improve functional outcomes more than BTI alone, however movement quality and speed only improved in the self-rehabilitation group. Participants in the self-rehabilitation group trained more than they were asked to, suggesting they found the program worthwhile. These clinically relevant findings justify larger-scale studies into the effects of self-rehabilitation to enhance the effects of BTI.