{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:11:36Z","timestamp":1788757896726,"version":"build-2803163510"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"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>Botulinum toxin type A (BoNT-A) effectively reduces focal spasticity. However, this pharmacological effect often fails to translate into consistent functional gains when patients receive conventional rehabilitation after injection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data from 102 patients with chronic stroke and finger flexor spasticity who received ultrasound-guided BoNT-A injections were retrospectively analyzed in a single-center cohort study. Patients were categorized into home-based modified constraint-induced movement therapy (h-mCIMT) or dose-matched conventional home-based occupational therapy (h-COT) according to post-injection rehabilitation strategies documented in clinical records. In routine clinical practice, rehabilitation was initiated around day 3 after injection and performed 5\u202fdays per week for 4\u202fweeks. Clinical outcomes, including distal FMA-UE, ARAT, MAL, and MAS, were extracted from routine assessments at baseline and follow-up visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 102 eligible patients, 98 had complete follow-up outcome records and were included in final analysis. Both cohorts exhibited comparable reductions in spasticity, suggesting similar pharmacological effects of BoNT-A. Compared with the h-COT cohort, the h-mCIMT cohort achieved significantly greater distal motor recovery at 4\u202fweeks and 3\u202fmonths, indicating superior functional hand performance. This was further reflected in greater real-world use of the affected limb, with significantly higher MAL scores at both follow-up assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Home-based modified constraint-induced movement therapy following BoNT-A injection provides a feasible and effective strategy to enhance distal motor recovery and real-world upper-limb use in chronic stroke. This combined intervention underscores the importance of structured, task-oriented rehabilitation during the post-injection therapeutic window as a key mechanism for maximizing functional recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1906566","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:23:50Z","timestamp":1788755030000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Home-based modified constraint-induced movement therapy improves distal motor outcomes after botulinum toxin A injection in chronic stroke"],"prefix":"10.3389","volume":"17","author":[{"given":"Wenjing","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurological Rehabilitation I, Xi\u2019an International Medical Center Hospital","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuya","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Neurological Rehabilitation I, Xi\u2019an International Medical Center Hospital","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Neurological Rehabilitation I, Xi\u2019an International Medical Center Hospital","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Neurological Rehabilitation I, Xi\u2019an International Medical Center Hospital","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Langfang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurological Rehabilitation I, Xi\u2019an International Medical Center Hospital","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurological Rehabilitation I, Xi\u2019an International Medical Center Hospital","place":["Xi\u2019an, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e153","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart disease and stroke 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