Upper limb spasticity is currently mainly managed with local toxin treatments. Recent studies
suggested combining botulinum toxin injections with splinting to optimise rehabilitation in
spastic patients. However, one study focused exclusively on lower limb spasticity, the second
on elbow flexor hypertonia, and the last on wrist and finger spasticity in children.
A study was performed in adult patients with upper limb spasticity treated with botulinum
toxin injections used as primary objective the tolerance for dynamic splinting. The authors
noted that the need for botulinum toxin was reduced in 2 patients out of 6. No study has been
conducted to date on the splinting + toxin combination in adults.
Another study showed that stretching sessions over 2 weeks of a muscle just given botulinum
toxin helped improve the toxin's efficacy 2, 6 and 12 weeks after the injection. For this
reason, rehabilitation teams routinely prescribe 10 sessions of physiotherapy for 15 days
after botulinum treatment.
Based on this principle, we hypothesise that dynamic night splinting applied just after
botulinum toxin treatment may also increase the toxin's efficacy. We chose a dynamic splint
providing continuous stretching of the wrist and fingers in extension whilst allowing active
flexion. Night splinting is thought to promote optimal functional use of the paretic upper
limb during the day and thus prevent learned non-use, which could worsen the spasticity.
Each patient will receive treatment cycles, whose results will be compared, so that each
patient will act as his/her own control. The evaluation will be based on the Tardieu scale
chosen for its greater inter-individual reproducibility and greater reliability to measure
The degree of extension of wrist and fingers provided by the splint will be adjusted to the
patient's clinical condition with the elastic tensioners. The purpose of the splint is to
maintain the stretch beyond the Tardieu spasticity angle at fast speed (V3) without reaching
maximum extension, which could be harmful.
This protocol is designed to determine whether dynamic night hand splinting combined with
botulinum toxin injections will improve botulinum antispastic efficacy in adults with brain