Botulinum toxin to treat upper-limb spasticity in hemiparetic patients: grasp strategies and kinematics of reach-to-grasp movements.

BACKGROUND Poor control of grasping in spastic, hemiparetic patients could be because of a combination of poor individuation of joints, weakness, spasticity, and sensory loss. OBJECTIVE To investigate the effect of botulinum toxin injections (BTIs) on grasping objects of different shapes and to assess the effect on upper-limb function, reach-to-grasp kinematics, and hand position and orientation at the time of grasp. METHODS We included 15 patients with spastic hemiparesis and 9 healthy controls in this open labeled study, in which the patients were assessed before (M0), 1 month after a first (M1), and 1 month after a second BTI (M4, at 4 months). A motion capture system recorded movements. Kinematic variables were computed as well as hand position and orientation at the time of grasping, and finger configurations were coded from video recordings. RESULTS In contrast with healthy participants, hemiparetic patients rarely used multipulpar grasps but used specific strategies combined with various directions of approach to the object. BTIs did not alter finger configuration but improved the final direction of the approach and the hand posture during the grasp. No significant changes in kinematic parameters were found using post hoc analysis, although a session effect was found for peak hand velocity. Individual analysis showed that the patients with the best potential for functional improvement are those with good proximal and moderate distal motor command. CONCLUSIONS BTIs can modify hand kinematics as well as the approach and posture of reach-to-grasp movements. Function and grasping strategies are probably more dependent on motor recovery.