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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
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Updated: Jun 25, 2026

Targeted Muscle Reinnervation: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain
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Published on: March 8, 2024

Dynamic splinting after treatment with botulinum toxin type-A: a randomized controlled pilot study.

Jenny M Lai1, Gerard E Francisco, F Buck Willis

  • 1Methodist Rehabilitation Associates, Houston, Texas, USA.

Advances in Therapy
|February 6, 2009
PubMed
Summary

Dynamic splinting combined with standard stroke care, including botulinum toxin type-A and manual therapy, significantly improved active range of motion in elbow extension for stroke survivors with hypertonia.

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Last Updated: Jun 25, 2026

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03:26

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Published on: March 8, 2024

Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Orthopedics

Background:

  • Stroke affects over 1.5 million Americans annually.
  • Hypertonia, characterized by excessive joint flexion or extension, is a common secondary complication of stroke.
  • This study addresses the need for effective treatments to manage post-stroke upper extremity spasticity and improve function.

Purpose of the Study:

  • To compare the efficacy of botulinum toxin type-A and manual therapy with adjunct dynamic splinting.
  • To evaluate the impact on range of motion, spasticity, and elbow flexor hypertonia.
  • To assess treatment effectiveness in a randomized trial setting.

Main Methods:

  • A pilot randomized trial involving 36 subjects with elbow flexion hypertonia post-stroke.
  • Standard care included botulinum toxin type-A injections and manual therapy.
  • Experimental group received adjunct dynamic splinting (Elbow Extension Dynasplint).
  • Outcome measures included active range of motion in elbow extension and the Modified Ashworth Scale for spasticity.

Main Results:

  • Thirty patients completed the study (mean age 52 years).
  • The experimental group showed a greater percentage increase in active range of motion (33.5%) compared to the control group (18.7%).
  • Both groups demonstrated comparable improvements in spasticity as measured by the Modified Ashworth Scale (9.3% vs. 8.6%).

Conclusions:

  • Botulinum toxin type-A is effective for tone management in stroke patients.
  • Occupational therapy plays a role in contracture reduction.
  • Dynamic splinting is valuable for maintaining and enhancing gains in range of motion after stroke.