Objective:

To compare BoNT-A effectiveness in plantar-flexor hyper-resistance stratified by contracture.

Approach:

• Study Design: Retrospective review of stroke survivors with spastic hemiplegia and ankle plantar-flexor hyper-resistance who received BoNT-A injections.
• Patient Stratification: Patients were divided into two groups based on passive ankle dorsiflexion: spasticity group (PROM limitation <7°) and spasticity-with-contracture group (PROM limitation ≥7°).
• Outcome Assessment: Outcomes were evaluated at baseline and at 2, 4, and 12 weeks post-injection using MAS, BRS, FMA lower-extremity subscore, and Barthel Index.

Key Findings:

• 107patientswereenrolled:54inthespasticitygroupand53inthespasticity-with-contracturegroup.BothgroupsshowedimprovementsinMASandBRSatallfollow-upvisits.FMAandBIimprovedinthespasticitygroupat4and12weeks;thespasticity-with-contracturegroupshowedimprovementonlyat12weeks.Between-groupanalysesindicatedconsistentlybetterMASandBRSscoresinthespasticitygroup,whilemedianFMAandBIwerenumericallyhigherinthisgroup,butthedifferencesdidnotreachstatisticalsignificance.

Interpretation:

BoNT-A significantly reduces post-stroke hyper-resistance and enhances motor function and daily living activities; however, the presence of contracture is linked to delayed and reduced improvement.

Limitations:

• Retrospective design may introduce selection bias.
• Lack of a universally agreed diagnostic criterion for contracture.

Conclusion:

BoNT-A is effective in reducing hyper-resistance post-stroke, but contracture may hinder recovery.