{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T09:50:47Z","timestamp":1780912247096,"version":"3.54.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T00:00:00Z","timestamp":1572480000000},"content-version":"vor","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Spasticity is one of the major complications after stroke. Botulinum toxin type A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve activities of daily living function of paretic arm. The recovery of functions of the affected arm is also the aim of robotic upper limb (UL) therapy. The motorized exoskeleton assists the patient in a large 3D work environment by promoting movement for the UL (shoulder, elbow, wrist, hand). The combination of the BoNT-A injection and the robotic therapy might enhance functional recovery after stroke. We reported the case of a chronic stroke patient in which the injection of BoNT-A was combined with multi-joint exoskeleton training. The patient showed improvement in the motor control of the UL, supporting the feasibility of this approach.<\/jats:p>","DOI":"10.1093\/omcr\/omz097","type":"journal-article","created":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T10:51:28Z","timestamp":1572519088000},"source":"Crossref","is-referenced-by-count":9,"title":["Upper limb motor improvement in chronic stroke after combining botulinum toxin A injection and multi-joints robot-assisted therapy: a case report"],"prefix":"10.1093","volume":"2019","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7267-3253","authenticated-orcid":false,"given":"Alex","family":"Martino Cinnera","sequence":"first","affiliation":[{"name":"Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Pucello","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Lupo","sequence":"additional","affiliation":[{"name":"Local Health Department Gaetano Pini, Rehabilitation Unit Fanny Finzi Ottolenghi, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Gimigliano","sequence":"additional","affiliation":[{"name":"Department of Mental and Physical health and Preventive Medicine, University of Campania \u2018Luigi Vanvitelli\u2019, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Mammucari","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario Lo","family":"Cicero","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Iosa","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Paolucci","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Morone","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,31]]},"reference":[{"key":"2019103110493193200_ref1","doi-asserted-by":"crossref","DOI":"10.3390\/toxins9070216","article-title":"Rehabilitation plus OnabotulinumtoxinA improves motor function over OnabotulinumtoxinA alone in post-stroke upper limb spasticity: a single-blind, randomized trial","volume":"9","author":"Devier","year":"2017","journal-title":"Toxins (Basel)"},{"key":"2019103110493193200_ref2","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/S1474-4422(04)00851-8","article-title":"Strategies for stroke rehabilitation","volume":"3","author":"Dobkin","year":"2004","journal-title":"Lancet Neurol"},{"key":"2019103110493193200_ref3","doi-asserted-by":"crossref","DOI":"10.1002\/pri.1718","article-title":"Effects of robot-assisted gait training in chronic stroke patients treated by botulinum toxin-a: a pivotal study","volume":"23","author":"Erbil","year":"2018","journal-title":"Physiother Res Int"},{"key":"2019103110493193200_ref4","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1161\/STROKEAHA.111.639831","article-title":"Poststroke spasticity management","volume":"43","author":"Francisco","year":"2012","journal-title":"Stroke"},{"key":"2019103110493193200_ref5","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/j.1468-1331.2009.02879.x","article-title":"Xeomin: an innovative new botulinum toxin type A","volume":"16","author":"Frevert","year":"2009","journal-title":"Eur J Neurol"},{"key":"2019103110493193200_ref6","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3389\/fneur.2019.00041","article-title":"Effectiveness of robot assisted upper limb training on spasticity, function andmuscle activity in chronic stroke patients treated with Botulinum toxin: a randomized single-blinded controlled trial","volume":"10","author":"Gandolfi","year":"2019","journal-title":"Front Neurol"},{"key":"2019103110493193200_ref7","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1113\/jphysiol.2012.246322","article-title":"Direct central action of intramuscularly injected botulinum toxin: is it harmful or beneficial?","volume":"591","author":"Kaji","year":"2013","journal-title":"J Physiol"},{"key":"2019103110493193200_ref8","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/1545968307305457","article-title":"Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review","volume":"22","author":"Kwakkel","year":"2008","journal-title":"Neurorehabil Neural Repair"},{"key":"2019103110493193200_ref9","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/17434440.2019.1574567","article-title":"Rehabilitative devices for a top-down approach","volume":"16","author":"Morone","year":"2019","journal-title":"Expert Rev Med Devices"},{"key":"2019103110493193200_ref10","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.5544","article-title":"Translational effects of robot-mediated therapy in subacute stroke patients: an experimental evaluation of upper limb motor recovery","volume":"6","author":"Palermo","year":"2018","journal-title":"PeerJ"},{"key":"2019103110493193200_ref11","first-page":"381","article-title":"How could robotic training and botolinum toxin be combined in chronic post stroke upper limb spasticity? A pilot study","volume":"51","author":"Pennati","year":"2015","journal-title":"Eur J Phys Rehabil Med"},{"key":"2019103110493193200_ref12","doi-asserted-by":"crossref","DOI":"10.1155\/2013\/153872","article-title":"Robotic technologies and rehabilitation: new tools for stroke patients\u2019 therapy","volume":"2013","author":"Poli","year":"2013","journal-title":"Biomed Res Int"},{"key":"2019103110493193200_ref13","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jns.2016.12.056","article-title":"Combined therapy using botulinum toxin A and single-joint hybrid assistive limb for upper-limb disability due to spastic hemiplegia","volume":"373","author":"Saita","year":"2017","journal-title":"J Neurol Sci"},{"key":"2019103110493193200_ref14","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1161\/01.STR.22.1.105","article-title":"Functional outcome measures in stroke rehabilitation","volume":"22","author":"Vanclay","year":"1991","journal-title":"Stroke"},{"key":"2019103110493193200_ref15","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1007\/s00415-010-5463-1","article-title":"Early development of spasticity following stroke: a prospective, observational trial","volume":"257","author":"Wissel","year":"2010","journal-title":"J Neurol"}],"container-title":["Oxford Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/omcr\/article-pdf\/2019\/10\/omz097\/30337541\/omz097.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/omcr\/article-pdf\/2019\/10\/omz097\/30337541\/omz097.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T10:51:35Z","timestamp":1572519095000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/omcr\/article\/doi\/10.1093\/omcr\/omz097\/5610568"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,1]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2019,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/omcr\/omz097","relation":{},"ISSN":["2053-8855"],"issn-type":[{"value":"2053-8855","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,10]]},"published":{"date-parts":[[2019,10,1]]},"article-number":"omz097"}}