Objective assessment of cortical activity changes in stroke patients before and after hand rehabilitation with and without botulinum toxin injection

I got nothing useful out of the botox I had for my left arm. Until we get a clinically
direct method for measuring spasticity we will never be able to measure improvements based upon interventions that are done. The Modified Ashworth Scale is way too subjective to be of any use in knowing if improvements are occurring. 
http://www.err.eg.net/article.asp?issn=1110-161X;year=2017;volume=44;issue=4;spage=172;epage=180;aulast=Abu-Bakr


Omnia A Abu-Bakr¹, Nagwaa M.M Nassar¹, Amal M Al-Ganzoury¹, Khaled Abo-Elfotouh Ahmed², Eman A Tawfik^1
1 Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
² Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Date of Submission	27-May-2016
Date of Acceptance	22-Jun-2017
Date of Web Publication	31-Oct-2017

Correspondence Address:
Omnia A Abu-Bakr
Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Abassia, Cairo
Egypt
Source of Support: None, Conflict of Interest: None

DOI: 10.4103/err.err_38_16

Abstract

Background Upper limb spasticity is a disabling condition and may result in severe functional limitation. The peripheral action of botulinum toxin (BTX) injection on spasticity is well known, but there are debates around its possible central action.
Aim The aim of this study was to assess the clinical, functional, and cortical activation outcome of two antispastic treatments for stroke of the hand and wrist. Thirty patients with upper limb poststroke spasticity were recruited in this study.
Patients and methods They were randomly allocated to two groups: group A and group B. Both groups received rehabilitation program, whereas group B received additional BTX injection. All patients were assessed at baseline and 8 weeks after treatment using the Modified Ashworth Scale, the Action Research Arm Test and Nine-Hole Peg Test, and somatosensory-evoked potential study of the median nerve.
Results Group B showed a higher percentage of change in Modified Ashworth Scale of the wrist flexors and long flexors of fingers and in Action Research Arm Test compared with group A.
Conclusion BTX injection in spastic muscles of the wrist and hand, followed by a rehabilitation program led to greater clinical and functional improvement compared with implementing the rehabilitation program alone.