Botulinum Toxin and Dynamic Splint Restore Grasping Function after Stroke: A Case Report

Area of Science:

• Neurorehabilitation
• Clinical Neurology
• Physical Medicine and Rehabilitation

Background:

• Evidence regarding upper extremity rehabilitation post-stroke remains inconclusive.
• Muscle spasticity significantly impairs motor function and quality of life in stroke survivors.
• Botulinum toxin injections and dynamic splinting are potential therapeutic interventions for upper extremity spasticity.

Observation:

• A 43-year-old female with chronic spastic hemiparesis post-ischemic stroke presented with severe left upper extremity mobility impairment.
• A 16-week intensive therapeutic program involved daily sessions focusing on grasping and releasing exercises, with and without a dynamic splint (SaeboFlex®).
• Treatment was augmented with botulinum toxin injections, with evaluations conducted pre-injection and at 6, 12, and 16 weeks.

Findings:

• Significant motor function improvement observed, with a 19.7% increase on the Fugl-Meyer Upper Extremity Assessment (FMA-UE).
• Spasticity reduced by one degree on the Modified Ashworth Scale, and pain decreased by one point on the Numerical Rating Scale (NRS).
• Objective measures indicated reduced muscle oscillation frequency and stiffness; patient regained grasping function and reported a 35% improvement in health-related quality of life.

Implications:

• The combined therapy of botulinum toxin and dynamic splinting effectively reduces disability and enhances quality of life in chronic spastic hemiparesis.
• This case study suggests a promising multimodal approach for upper extremity rehabilitation post-stroke.
• Further research is warranted to validate these findings in larger cohorts and explore long-term outcomes.