{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:23:56Z","timestamp":1786641836330,"version":"build-2736575974"},"reference-count":84,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T00:00:00Z","timestamp":1723075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ETH Career Seed","award":["SEED-32 21-2"],"award-info":[{"award-number":["SEED-32 21-2"]}]},{"name":"Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich","award":["SEED-32 21-2"],"award-info":[{"award-number":["SEED-32 21-2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Upper-limb spasticity, frequent after central nervous system lesions, is typically treated with botulinum neurotoxin type A (BoNT-A) injections to reduce muscle tone and increase range of motion. However, performing adjunct physical therapy post-BoNT-A can be challenging due to residual weakness or spasticity. This study evaluates the feasibility of hand therapy using a robotic hand orthosis (RELab tenoexo) with a mobile phone application as an adjunct to BoNT-A injections. Five chronic spastic patients participated in a two-session pilot study. Functional (Box and Block Test (BBT), Action Research Arm Test (ARAT)), and muscle tone (Modified Ashworth Scale (MAS)) assessments were conducted to assess functional abilities and impairment, along with usability evaluations. In the first session, subjects received BoNT-A injections, and then they performed a simulated unsupervised therapy session with the RELab tenoexo in a second session a month later. Results showed that BoNT-A reduced muscle tone (from 12.2 to 7.4 MAS points). The addition of RELab tenoexo therapy was safe, led to functional improvements in four subjects (two-cube increase in BBT as well as 2.8 points in grasp and 1.3 points in grip on ARAT). Usability results indicate that, with minor improvements, adjunct RELab tenoexo therapy could enhance therapy doses and, potentially, long-term outcomes.<\/jats:p>","DOI":"10.3390\/toxins16080346","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T07:01:25Z","timestamp":1723100485000},"page":"346","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Feasibility of Adjunct Therapy with a Robotic Hand Orthosis after Botulinum Toxin Injections in Persons with Spasticity: A Pilot Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Raffaele","family":"Ranzani","sequence":"first","affiliation":[{"name":"Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37\/39, 8092 Zurich, Switzerland"},{"name":"School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell\u2019Ateneo Nuovo 1, 20126 Milan, Italy"},{"name":"Cereneo, Center for Neurology and Rehabilitation, Seestrasse 18, 6354 Vitznau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Razzoli","sequence":"additional","affiliation":[{"name":"Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37\/39, 8092 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Sanson","sequence":"additional","affiliation":[{"name":"Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37\/39, 8092 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0712-2425","authenticated-orcid":false,"given":"Jaeyong","family":"Song","sequence":"additional","affiliation":[{"name":"Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37\/39, 8092 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Galati","sequence":"additional","affiliation":[{"name":"Faculty of Biomedical Sciences, Universit\u00e0 della Svizzera Italiana, 6962 Lugano, Switzerland"},{"name":"Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7499-6600","authenticated-orcid":false,"given":"Carlo","family":"Ferrarese","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell\u2019Ateneo Nuovo 1, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Lambercy","sequence":"additional","affiliation":[{"name":"Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37\/39, 8092 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5249-073X","authenticated-orcid":false,"given":"Alain","family":"Kaelin-Lang","sequence":"additional","affiliation":[{"name":"Faculty of Biomedical Sciences, Universit\u00e0 della Svizzera Italiana, 6962 Lugano, Switzerland"},{"name":"Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Gassert","sequence":"additional","affiliation":[{"name":"Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37\/39, 8092 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1212\/WNL.30.12.1303","article-title":"The Control of Muscle Tone, Reflexes, and Movement: Robert Wartenbeg Lecture","volume":"30","author":"Lance","year":"1980","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/09638280400014576","article-title":"Spasticity: Clinical Perceptions, Neurological Realities and Meaningful Measurement","volume":"27","author":"Pandyan","year":"2005","journal-title":"Disabil. 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