Home-based modified constraint-induced movement therapy improves distal motor outcomes after botulinum toxin A injection in chronic stroke.

BACKGROUND

Botulinum toxin type A (BoNT-A) effectively reduces focal spasticity. However, this pharmacological effect often fails to translate into consistent functional gains when patients receive conventional rehabilitation after injection.

METHODS

Clinical data from 102 patients with chronic stroke and finger flexor spasticity who received ultrasound-guided BoNT-A injections were retrospectively analyzed in a single-center cohort study. Patients were categorized into home-based modified constraint-induced movement therapy (h-mCIMT) or dose-matched conventional home-based occupational therapy (h-COT) according to post-injection rehabilitation strategies documented in clinical records. In routine clinical practice, rehabilitation was initiated around day 3 after injection and performed 5 days per week for 4 weeks. Clinical outcomes, including distal FMA-UE, ARAT, MAL, and MAS, were extracted from routine assessments at baseline and follow-up visits.

RESULTS

Of the 102 eligible patients, 98 had complete follow-up outcome records and were included in final analysis. Both cohorts exhibited comparable reductions in spasticity, suggesting similar pharmacological effects of BoNT-A. Compared with the h-COT cohort, the h-mCIMT cohort achieved significantly greater distal motor recovery at 4 weeks and 3 months, indicating superior functional hand performance. This was further reflected in greater real-world use of the affected limb, with significantly higher MAL scores at both follow-up assessments.

CONCLUSION

Home-based modified constraint-induced movement therapy following BoNT-A injection provides a feasible and effective strategy to enhance distal motor recovery and real-world upper-limb use in chronic stroke. This combined intervention underscores the importance of structured, task-oriented rehabilitation during the post-injection therapeutic window as a key mechanism for maximizing functional recovery.