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Research Article  |   July 2008
Augmenting Occupational Therapy Treatment of Upper-Extremity Spasticity With Botulinum Toxin A: A Case Report of Progress at Discharge and 2 Years Later
Author Affiliations
  • Susan P. Denham, EdD, OTR/L, CHT, is Assistant Professor of Occupational Therapy, College of Health Sciences, Alabama State University, 164 Tensaw Road, Montgomery, AL 36117; sdenham@alasu.edu
Article Information
Hand and Upper Extremity / Musculoskeletal Impairments / Neurologic Conditions / Splinting / Stroke / Wound Management / Rehabilitation, Disability, and Participation
Research Article   |   July 2008
Augmenting Occupational Therapy Treatment of Upper-Extremity Spasticity With Botulinum Toxin A: A Case Report of Progress at Discharge and 2 Years Later
American Journal of Occupational Therapy, July/August 2008, Vol. 62, 473-479. doi:10.5014/ajot.62.4.473
American Journal of Occupational Therapy, July/August 2008, Vol. 62, 473-479. doi:10.5014/ajot.62.4.473
Abstract

This case report summarizes occupational therapy services provided to a participant after botulinum toxin A (BTA) injections and her improvements 2 years later. The injections were performed to neutralize spasticity in the left upper extremity after a stroke. Along with BTA, the participant received occupational therapy for 12 weeks, using neurodevelopmental and biomechanical approaches and an activity-based home program. Spasticity decreased from a 4 to a 1 on the Modified Ashworth Scale (MAS) immediately after the injections. Two years after the injections, the MAS score ranged between 1 and 1+. Initially, the participant demonstrated functional limitations in areas of splint application, dressing, toileting, and bathing. Following BTA injections and occupational therapy, the participant demonstrated increased independence in all deficit areas. For this participant, BTA, combined with functional, activity-based occupational therapy interventions, was associated with neurological change and greater functional use of the spastic limb.