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Modified Constraint-Induced Therapy and Botulinum Toxin A: A Promising Combination

Page, Stephen J. PhD; Elovic, Elie MD; Levine, Peter BA, PTA; Sisto, Sue Ann PT, PhD

American Journal of Physical Medicine & Rehabilitation: January 2003 - Volume 82 - Issue 1 - p 76-80
Case Report: Hemiplegia

Page SJ, Elovic E, Levine P, Sisto SA: Modified constraint-induced therapy and botulinum toxin A: A promising combination. Am J Phys Med Rehabil 2003;82:76–80.

Modified constraint-induced therapy and chemodenervation with botulinum toxin A are each efficacious in managing stroke-induced motor disorders; however, the application of these two promising modalities in combination is yet to be examined. This case study describes a 44-yr-old man who experienced a right middle cerebral artery infarct 14 mo before participating in modified constraint-induced therapy. After modified constraint-induced therapy completion, the patient exhibited substantial improvement in affected upper limb use and function but retained difficulty with finger extension secondary to hypertonicity and spasticity in the forearm flexor muscles. Selective chemodenervation of these muscles with botulinum toxin A greatly improved the patient’s self-reported hand function and his scores using objective measures. The authors of this paper present this case to raise the idea of increasing treatment efficacy by combining these two modalities.

From the Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey (SJP, EE, PL, SAS); and the Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry/New Jersey Medical School, Newark, New Jersey (SJP, EE, SAS).

Current affiliation for Dr. Page: Department of Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine, Cincinnati, OH.

Supported by a grant from the Wallerstein Foundation for Geriatric Life Improvement.

All correspondence and requests for reprints should be addressed to Stephen J. Page, PhD, Department of Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine, 202 Goodman Drive, Suite 275, Cincinnati, OH 45267.

© 2003 Lippincott Williams & Wilkins, Inc.