The identification of people after stroke whose hand function would be improved by the injection of tight (spastic) muscles in the hand and arm with a paralysing agent (botulinum toxin)

Many stroke survivors have significant ongoing difficulties using their affected hand for everyday tasks. Letting go of grasped objects is often described as being slow and effortful, most likely caused by over activity and increased tone of the muscles that bend the wrist and close the hand. It is known that injecting botulinum toxin (BoTox) will reduce muscle tone and relax the hand, but it is not known whether this treatment will improve the active use of the hand in everyday tasks. 

This study will use two new measures to address whether botulinum toxin can be used to effectively improve everyday use of the hand in addition to physiotherapy treatment. The first measure is how the hand is used in a functional task of placing a glass on a target and letting it go. The second measure is a specifically developed motor to accurately measure the muscle tone, with and without the injection of botulinum toxin. The study will identify indicators to predict who would benefit from the injection so that the treatment is used appropriately and people do not have ineffective and unnecessary injections.

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