Disclosures: Nathaniel H. Mayer, MD: Allergan (Products/Services: Yes) (Research Grant or Support)

Objective : To show proof of concept that chemodenervation of spastic finger muscles improves ‘hand as a holder’ function by resulting in an increase in the size of objects inserted for holding by the spastic hand

Design: Behavioral performance tasks (cylinder insertions, 5 different diameters, 3 trials each, into the spastic hand) evaluated at two pre-chemodenervation sessions and one post-chemodenervation session (135 insertion attempts each baseline before chemodenervation, 135 attempts after chemodenervation)

Setting : Outpatient setting of a tertiary rehabilitation hospital

Participants : 9 patients, chronic (> 24 months) unilateral spastic hemiparesis, flexed fist without voluntary finger /thumb extension

Interventions: As part of routine clinical care, participants were treated with chemodenervation after two baseline evaluations. Success was considered an inserted cylinder held independently for at least 5 seconds by the spastic hand.

Main Outcome Measures: The fraction of successful cylinder holds achieved during each evaluation session

Results: The incidence ratio (IRR) of successful holds was 26% higher after chemodenervation compared with the second pre-chemodenervation session (IRR = 1.26, 95% CI: 1.02, 1.57; p =0.036), while the incidence rates of successful holds were very similar (not significantly different) for the pre-chemodenervation 1 and pre-chemodenervation 2 sessions.

Conclusions: An important hand function is to acquire and hold objects. This study provides proof of concept that chemodenervation of the spastic hand can improve ‘hand as a holder’ function. Of relevance to physiatrists, the study’s approach points out that mitigation of hypertonia can be measured functionally in contrast to the more ubiquitous, but functionally less relevant, neurological measures such as Ashworth or Tardieu scores.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chemodenervation-effect-on-hand-as-a-holder-function-of-the-spastic-hand/