Article

OBJECTIVE: To determine whether baseline hand spastic hemiparesis assessed by the
Chedoke-McMaster Assessment influences functional improvement after botulinum
toxin type A (BTX-A) injections and postinjection therapy. DESIGN: Prospective
cohort study. SETTING: Outpatient spasticity clinic. PARTICIPANTS: Participants
(N=14) with spastic hemiparesis divided into 2 groups: Chedoke-McMaster
Assessment Hand-Higher Function (stage> or =4, n=5) and Chedoke-McMaster
Assessment Hand-Lower Function (stage=2 or 3, n=9). INTERVENTIONS: Upper-limb
BTX-A injections followed by 6 weeks of postinjection therapy. MAIN OUTCOME
MEASURES: Primary outcomes were Motor Activity Log-28 and Motor Activity Log
items. Secondary outcomes were Action Research Arm Test (ARAT), Motor Activity
Log-Self-Report, and Modified Ashworth Scale (MAS). Measures were assessed at
baseline (preinjection), 6 weeks, 9 weeks, and 12 weeks postinjection. RESULTS:
Primary and secondary outcomes improved significantly over time in both groups.
Although no significant differences in ARAT or MAS change scores were noted
between groups, Chedoke-McMaster Assessment Hand-Higher Function group
demonstrated greater change on Motor Activity Log-28 (P=.013) from baseline to 6
weeks and Motor Activity Log items (P=.006) from baseline to 12 weeks compared to
Chedoke-McMaster Assessment Hand-Lower Function group. CONCLUSIONS: BTX-A
injections and postinjection therapy improved hand function and reduced
spasticity for both Chedoke-McMaster Assessment Hand-Higher Function and
Chedoke-McMaster Assessment Hand-Lower Function groups. Clinicians should expect
to see larger gains for persons with less baseline impairment.

Langue : ANGLAIS