{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:01:55Z","timestamp":1782975715640,"version":"3.54.5"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Technology Development Program of Jilin Province","award":["20250203030SF"],"award-info":[{"award-number":["20250203030SF"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-stroke muscle hyper-resistance is produced by both neurogenic (spasticity) and non-neurogenic (contracture) factors. BoNT-A is the most effective intervention for post-stroke spasticity, yet whether concomitant contracture alters its therapeutic benefit remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare BoNT-A effectiveness in plantar-flexor hyper-resistance stratified by contracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed stroke survivors with spastic hemiplegia and ankle plantar-flexor hyper-resistance who received BoNT-A injections. Patients were stratified into two groups according to the presence of restricted passive ankle dorsiflexion: the spasticity group (PROM limitation &amp;lt;7\u00b0) and the spasticity-with-contracture group (PROM limitation \u22657\u00b0). Outcomes were assessed at baseline and at 2, 4 and 12\u202fweeks post-injection, including the Modified Ashworth Scale (MAS) for plantar-flexors, Brunnstrom Recovery Stage (BRS), Fugl\u2013Meyer Assessment (FMA) lower-extremity subscore and Barthel Index (BI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 107 patients were enrolled\u201454 in the spasticity group and 53 in the spasticity-with-contracture group. Baseline comparison revealed a significantly longer disease duration in the spasticity-with-contracture group; other characteristics were comparable. Both groups achieved improvements in MAS and BRS at all three follow-up visits. FMA and BI improved in the spasticity group at 4 and 12\u202fweeks, whereas the spasticity-with-contracture group showed improvement only at 12\u202fweeks. Between-group analyses indicated that MAS and BRS scores were consistently better in the spasticity group at each time point; although median FMA and BI were numerically higher in this group, the differences did not reach statistical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BoNT-A markedly reduces post-stroke hyper-resistance and enhances motor function and activities of daily living; by contrast, concomitant contracture is associated with delayed and attenuated improvement in MAS and BRS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1836266","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:34:50Z","timestamp":1782970490000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing the real-world effectiveness of botulinum toxin type A injections across distinct poststroke muscle hyper-resistance patterns"],"prefix":"10.3389","volume":"17","author":[{"given":"Xuncan","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanmin","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoxing","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinxing","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenlan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The First Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3132","DOI":"10.1161\/STROKEAHA.111.639831","article-title":"Poststroke spasticity management","volume":"43","author":"Francisco","year":"2012","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"892165","DOI":"10.3389\/fneur.2022.892165","article-title":"Cannabinoid effect and safety in spasticity following stroke: a double-blind randomized placebo-controlled study","volume":"13","author":"Marinelli","year":"2022","journal-title":"Front 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A randomised controlled trial","volume":"35","author":"Lindsay","year":"2021","journal-title":"Clin Rehabil"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"383","DOI":"10.3390\/toxins16090383","article-title":"Long-term Management of Post-Stroke Spasticity with botulinum toxin: a retrospective study","volume":"16","author":"Falcone","year":"2024","journal-title":"Toxins"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"267","DOI":"10.3390\/toxins16060267","article-title":"Long-term enhancement of botulinum toxin injections for post-stroke spasticity by use of stretching exercises-a randomized controlled trial","volume":"16","author":"Hwang","year":"2024","journal-title":"Toxins"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"565","DOI":"10.23736\/s1973-9087.22.07136-2","article-title":"A systematic review on extracorporeal shock wave therapy and botulinum toxin for spasticity treatment: a comparison on efficacy","volume":"58","author":"Mihai","year":"2022","journal-title":"Eur J Phys Rehabil Med"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1836266\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:34:51Z","timestamp":1782970491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1836266\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":20,"alternative-id":["10.3389\/fneur.2026.1836266"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1836266","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"article-number":"1836266"}}