{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:04:38Z","timestamp":1792253078029,"version":"4.4.0"},"reference-count":28,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2019,8,2]],"date-time":"2019-08-02T00:00:00Z","timestamp":1564704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["Grants-in-Aid for Scientific Research (c) 18K10691"],"award-info":[{"award-number":["Grants-in-Aid for Scientific Research (c) 18K10691"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>The short-term effects of botulinum toxin type A (BoNT-A) treatment in stroke patients with upper extremity are well established. This study examined the association between the recovery of motor function of the upper extremity with subjective physical symptoms in outpatients receiving long-term BoNT-A and occupational therapy following stroke. We also investigated the expectations of patients who elected to continue treatment. Forty-seven patients (23 men and 24 women) aged 61 years received BoNT-A treatment more than 20 times. The subjective physical status was analyzed by using the visual analogue scale score through an eight-item questionnaire. Recovery of motor function in the upper extremity was detected by calculating the change (delta) in Fugl\u2013Mayer Assessment (FMA), and ordinal logistic modeling analysis was used to determine the association between the delta-FMA score and the subjective level of agreement for each item. When the ordinal logistic modeling fit was statistically significant, results were interpreted as having logistic probability. The logistic curves discriminating one point (strongly disagree) from five points (strongly agree) were fit in a stepwise fashion. This study suggests that patients receiving long-term BoNT-A treatment and occupational therapy experienced an increased upper extremity mitigation and decreased insomnia after injection, regardless of the recovery of motor function.<\/jats:p>","DOI":"10.3390\/toxins11080453","type":"journal-article","created":{"date-parts":[[2019,8,2]],"date-time":"2019-08-02T11:58:16Z","timestamp":1564747096000},"page":"453","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Association of Long-Term Treatment by Botulinum Neurotoxins and Occupational Therapy with Subjective Physical Status in Patients with Post-Stroke Hemiplegia"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5645-0439","authenticated-orcid":false,"given":"Toyohiro","family":"Hamaguchi","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan"},{"name":"Department of Rehabilitation, Graduate School of Health Sciences, Saitama Prefectural University, Saitama 343-8540, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6701-4974","authenticated-orcid":false,"given":"Masahiro","family":"Abo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Kenmoku","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izumi","family":"Yoshizawa","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Tokyo Kasei University, Saitama 350-1398, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Nakaya","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Graduate School of Health Sciences, Saitama Prefectural University, Saitama 343-8540, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2089-0672","authenticated-orcid":false,"given":"Kensuke","family":"Taguchi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,2]]},"reference":[{"key":"ref_1","first-page":"534","article-title":"Continuum of reflex excitability in hemiplegia: Influence of muscle length and muscular transformation after heel-cord lengthening and immobilization on the pathophysiology of spasticity and clonus","volume":"41","author":"Lin","year":"1999","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"465","DOI":"10.3389\/fneur.2019.00465","article-title":"Spasticity assessment based on the maximum isometrics voluntary contraction of upper limb muscles in post-stroke hemiplegia","volume":"10","author":"Wang","year":"2019","journal-title":"Front. Neurol."},{"key":"ref_3","first-page":"140","article-title":"Post-stroke hemiplegia and adl-performance","volume":"7","author":"Jaasko","year":"1980","journal-title":"Scand. J. Rehabil. Med. Suppl."},{"key":"ref_4","first-page":"731","article-title":"Associations between results of post-stroke ndt-bobath rehabilitation in gait parameters, adl and hand functions","volume":"22","author":"Mikolajewska","year":"2013","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"440","DOI":"10.2340\/16501977-0066","article-title":"Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial","volume":"39","author":"Marco","year":"2007","journal-title":"J. Rehabil. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1097\/PHM.0b013e31826ecb02","article-title":"Does botulinum toxin type a decrease pain and lessen disability in hemiplegic survivors of stroke with shoulder pain and spasticity? A randomized, double-blind, placebo-controlled trial","volume":"91","author":"Marciniak","year":"2012","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_7","unstructured":"Society, T.J.S. (2017). Japanese Guidelines for the Management of Stroke 2015, Kyowa Planning Co., Ltd."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1136\/jnnp.2003.034702","article-title":"Botulinum toxin in clinical practice","volume":"75","author":"Jankovic","year":"2004","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.toxicon.2017.09.006","article-title":"Design of modified botulinum neurotoxin a1 variants with a shorter persistence of paralysis and duration of action","volume":"139","author":"Scheps","year":"2017","journal-title":"Toxicon"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jns.2012.05.008","article-title":"Bont-a related changes of cortical activity in patients suffering from severe hand paralysis with arm spasticity following ischemic stroke","volume":"319","author":"Veverka","year":"2012","journal-title":"J. Neurol. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1136\/jnnp.61.1.30","article-title":"Use of botulinum toxin in stroke patients with severe upper limb spasticity","volume":"61","author":"Bhakta","year":"1996","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1080\/09638288.2017.1400596","article-title":"A survey of the current practice of intramuscular Botulinum toxin injections for hemiplegic shoulder pain in the UK","volume":"41","author":"Holmes","year":"2019","journal-title":"Disabil. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ekstrand, E., Alt Murphy, M., Persson, H.C., Lundgren-Nilsson, A., and Sunnerhagen, K.S. (2019). Which clinical and sociodemographic determinants are associated with self-perceived manual ability at one year after stroke?. Disabil. Rehabil., 1\u20138.","DOI":"10.1080\/09638288.2018.1557265"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e020915","DOI":"10.1136\/bmjopen-2017-020915","article-title":"Effects of a 6-month self-rehabilitation programme in addition to botulinum toxin injections and conventional physiotherapy on limitations of patients with spastic hemiparesis following stroke (adju-tox): Protocol study for a randomised controlled, investigator blinded study","volume":"8","author":"Bonnyaud","year":"2018","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Field, M., Splevins, A., Picaut, P., van der Schans, M., Langenberg, J., Noort, D., and Foster, K. (2018). AbobotulinumtoxinA (Dysport\u00ae), OnabotulinumtoxinA (Botox\u00ae), and IncobotulinumtoxinA (Xeomin\u00ae) neurotoxin content and potential implications for duration of response in patients. Toxins, 10.","DOI":"10.3390\/toxins10120535"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s12325-018-0833-7","article-title":"Incobotulinumtoxina efficacy and safety in adults with upper-limb spasticity following stroke: Results from the open-label extension period of a phase 3 study","volume":"36","author":"Marciniak","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/0304-3959(94)00178-H","article-title":"When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function","volume":"61","author":"Serlin","year":"1995","journal-title":"Pain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jpainsymman.2007.03.012","article-title":"Establishing mild, moderate, and severe scores for cancer-related symptoms: How consistent and clinically meaningful are interference-based severity cut-points?","volume":"35","author":"Given","year":"2008","journal-title":"J. Pain Symptom Manag."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.annrmp.2004.08.006","article-title":"Botulinum toxin and medical liability: Is the patient sufficiently informed?","volume":"48","author":"Foucault","year":"2005","journal-title":"Ann. Readapt. Med. Phys."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/j.1468-1331.2010.03129.x","article-title":"Botulinum toxin assessment, intervention and after-care for upper limb hypertonicity in adults: International consensus statement","volume":"17","author":"Sheean","year":"2010","journal-title":"Eur. J. Neurol."},{"key":"ref_21","first-page":"72","article-title":"Improving consent procedures and evaluation of treatment success in cosmetic use of incobotulinumtoxina: An assessment of the treat-to-goal approach","volume":"12","author":"Jandhyala","year":"2013","journal-title":"J. Drugs Dermatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/S0168-6054(07)80001-8","article-title":"The risk-benefit of high doses of botulinum toxin injections for muscle spasticity","volume":"50","author":"Rousseaux","year":"2007","journal-title":"Ann. Readapt. Med. Phys."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.toxicon.2012.11.025","article-title":"Evidence-based review and assessment of botulinum neurotoxin for the treatment of adult spasticity in the upper motor neuron syndrome","volume":"67","author":"Esquenazi","year":"2013","journal-title":"Toxicon"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1212\/WNL.0000000000002560","article-title":"Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the guideline development subcommittee of the american academy of neurology","volume":"86","author":"Simpson","year":"2016","journal-title":"Neurology"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Devier, D., Harnar, J., Lopez, L., Brashear, A., and Graham, G. (2017). Rehabilitation plus onabotulinumtoxina improves motor function over onabotulinumtoxina alone in post-stroke upper limb spasticity: A single-blind, randomized trial. Toxins, 9.","DOI":"10.3390\/toxins9070216"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2340\/1650197771331","article-title":"The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance","volume":"7","author":"Jaasko","year":"1975","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G *power 3.1: Tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav. Res. Methods"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e14958","DOI":"10.1097\/MD.0000000000014958","article-title":"Relationship between knee extension strength and gait styles in patients with dementia","volume":"98","author":"Nakayama","year":"2019","journal-title":"Medicine"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/11\/8\/453\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:12:41Z","timestamp":1760188361000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/11\/8\/453"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,2]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8]]}},"alternative-id":["toxins11080453"],"URL":"https:\/\/doi.org\/10.3390\/toxins11080453","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,2]]}}}