POST-STROKE FOCAL HAND DYSTONIA

BOTULINUM TOXIN AND TASK SPECIFIC TRAINING

Abstract

Objectives: To determine the effects of Botulinum toxin A (BoNTA) with task
specific training on hand function and quality of life in patients with post stroke focal dystonia of
hand. Study Design: Randomized Controlled Trial. Place and Duration of Study: This study
was conducted in Holy family hospital, The Neurocounsel and Chambeli Rehabilitation center
from October 2015 to September 2016. Methodology: Both male and female patients suffering
from stroke for at least 6 months with focal hand dystonia were included in this randomized
controlled trial. 46 patients were recruited in the study through non probability purposive
sampling and then were allocated to control (n=23) and experimental group (n=23) by random
number list generated for 46 patients using SPSS software. Control group was provided with
only task specific training while experimental group was provided with an injection of Botulinum
Toxin A in addition to task-specific training. Data was collected from both groups at baseline
and then after 8 weeks by using Action Research Arm Test (ARAT), Stroke specific quality
of life (SS-QOL) and Arm dystonia disability scale (ADDS). Results: Although both groups
showed significant improvements after training(P value <0.001) in both ARAT scale and SSQOL
but as shown by the difference of means of the groups, experimental group has shown
more improvement than control group at the end of 8 weeks of intervention with P value<0.05.
ADDS has also shown better results in reducing disability in experimental group as compared to
control group. Conclusion: Botulinum toxin A prior to start of task specific training significantly
improves outcome in post stroke focal hand dystonia patients than task specific training alone.