Article

OBJECTIVE: To determine whether onabotulinumtoxinA injections and task practice
training with or without functional electrical stimulation (FES) improve upper
limb motor function in chronic spastic hemiparesis. DESIGN: Randomized controlled
trial. SETTING: Outpatient spasticity clinic. PARTICIPANTS: Participants (N=23)
had chronic spastic hemiparesis with moderate-severe hand impairment based on
Chedoke-McMaster Assessment greater than or equal to 2. INTERVENTIONS:
OnabotulinumtoxinA injections followed by 12 weeks of postinjection task
practice. Participants randomly assigned to FES group were also fitted with an
orthosis that provided FES. MAIN OUTCOME MEASURES: Motor Activity Log
(MAL)-Observation was the primary outcome. Secondary outcomes were Action
Research Arm Test (ARAT) and MAL-Self-Report.
RESULTS: For the entire cohort,
MAL-Observation mean item scores improved significantly from baseline to week 6
(P=.005) but did not remain significant at week 12. MAL-Self-Report mean item
scores improved significantly (P=.009) from baseline to week 6 and remained
significantly higher (P=.014) at week 12. ARAT total scores also improved
significantly from baseline to week 6 (P=.018) and were sustained at week 12
(P=.032). However, there were no significant differences between the FES and
no-FES groups for any outcome variable over time. CONCLUSIONS: Rehabilitation
strategies that combine onabotulinumtoxinA injections and task practice therapy
are feasible and effective in improving upper-limb motor function and reducing
spasticity in patients with chronic spastic hemiparesis. However, the cyclic FES
protocol used in this study did not increase gains achieved with the combination
of onabotulinumtoxinA and task practice alone.

Langue : ANGLAIS