Home-based modified constraint-induced movement therapy (h-mCIMT) following botulinum toxin A injection provides a feasible and effective strategy to enhance distal motor recovery and real-world upper-limb use in chronic stroke compared to conventional home-based occupational therapy.
Key Findings
Results
Both the h-mCIMT and h-COT cohorts exhibited comparable reductions in spasticity following BoNT-A injection, suggesting similar pharmacological effects between groups.
Spasticity was measured using the Modified Ashworth Scale (MAS)
Comparable MAS reductions indicate that differences in functional outcomes were attributable to the rehabilitation strategy rather than differential pharmacological response
This finding supports the premise that pharmacological spasticity reduction alone does not consistently translate into functional gains
Ultrasound-guided BoNT-A injections were administered to patients with finger flexor spasticity
Results
The h-mCIMT cohort achieved significantly greater distal motor recovery compared to the h-COT cohort at both 4 weeks and 3 months post-injection.
Distal motor recovery was assessed using the distal Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT)
Differences were significant at the 4-week follow-up assessment
Differences were maintained at the 3-month follow-up assessment, indicating durability of the benefit
Rehabilitation was initiated around day 3 after injection and performed 5 days per week for 4 weeks
Results
Patients in the h-mCIMT cohort demonstrated greater real-world use of the affected limb, reflected in significantly higher Motor Activity Log (MAL) scores at both follow-up time points.
MAL scores were significantly higher in the h-mCIMT group at both 4 weeks and 3 months
MAL measures real-world use of the affected upper limb in daily activities
This indicates that functional gains from h-mCIMT translated into actual everyday limb use, not just laboratory-based performance
The superiority in MAL scores was observed at both early (4-week) and later (3-month) follow-up assessments
Methods
Of 102 eligible patients with chronic stroke and finger flexor spasticity, 98 had complete follow-up outcome records and were included in the final analysis.
This was a retrospective, single-center cohort study
Patients were categorized into h-mCIMT or dose-matched conventional home-based occupational therapy (h-COT) based on post-injection rehabilitation strategies documented in clinical records
Clinical outcomes including distal FMA-UE, ARAT, MAL, and MAS were extracted from routine assessments at baseline and follow-up visits
4 patients were excluded from the final analysis due to incomplete follow-up outcome records
Discussion
Structured, task-oriented rehabilitation during the post-injection therapeutic window was identified as a key mechanism for maximizing functional recovery after BoNT-A injection in chronic stroke.
The post-injection therapeutic window is the period during which spasticity is pharmacologically reduced, potentially enabling more effective motor relearning
h-mCIMT is characterized as a structured, task-oriented approach compared to conventional occupational therapy
The findings underscore that rehabilitation strategy selection following BoNT-A injection is critical to functional outcomes
The authors concluded that the combined intervention of BoNT-A plus h-mCIMT is a 'feasible and effective strategy to enhance distal motor recovery and real-world upper-limb use in chronic stroke'
What This Means
This research suggests that the type of rehabilitation therapy performed after botulinum toxin (Botox) injections for stroke-related hand stiffness makes a significant difference in recovery outcomes. The study followed 98 chronic stroke survivors who received ultrasound-guided Botox injections to reduce finger muscle spasticity, then compared those who performed a home-based modified version of constraint-induced movement therapy (which restricts the unaffected arm to force use of the affected arm) against those who performed conventional home-based occupational therapy. Both groups experienced similar reductions in muscle stiffness from the injection itself, but the group doing the specialized therapy showed meaningfully greater improvement in hand and finger movement ability, both at one month and three months after injection.
Importantly, the benefits were not just seen in clinical tests — patients doing the specialized home therapy also showed greater actual use of their affected arm in everyday life, as measured by the Motor Activity Log. This suggests the therapy helped people not only move their hand better in a testing situation but also choose to use it more in their daily routines. The therapy was started about three days after injection and carried out five days per week for four weeks, indicating it is a structured but home-based approach that does not require repeated clinic visits.
This research suggests that the period immediately following a Botox injection — when spasticity is reduced — represents an important window of opportunity for intensive, targeted rehabilitation. Simply receiving Botox without a structured exercise program may not be enough to convert reduced spasticity into real-world functional improvement. For stroke survivors with persistent hand stiffness, combining Botox injections with a structured home therapy program focused on using the affected arm may offer better outcomes than standard rehabilitation alone.
Zhang W, Mei S, Wen M, Jiao K, Zhao L, Zhang R. (2026). Home-based modified constraint-induced movement therapy improves distal motor outcomes after botulinum toxin A injection in chronic stroke.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1906566