BACKGROUND: Botulinum Toxin injections are used to treat spasticity in stroke. Although this treatment is effective on muscle tone, its effect on functional gait-related activities remains uncertain. OBJECTIVE: The aim of this randomized controlled trial was to determine the effect of a self-rehabilitation programme as an adjunct to Botulinum Toxin injections on gait-related activities in patients with chronic hemiparesis. METHODS: Thirty-five outpatients were included. Each patient was randomized to 1 of 2 groups: Botulinum Toxin plus standardized self-rehabilitation programme (R group, n = 19) or Botulinum Toxin alone (C group, n = 16). Each patient was evaluated with the following tests before Botulinum Toxin injections and one month afterwards: 10-m timed walk, Timed Up and Go, distance covered in 6 min over an ecological circuit, and the stair test. RESULTS: There were significant improvements in the R group compared with the C group: maximal gait speed improved by 8% (p = 0.003); distance covered in 6 min over an ecological circuit increased by 7.1% (p = 0.01); and time to ascend and to descend a flight of stairs decreased by 9.8% (p = 0.003) and 6.6% (p = 0.009), respectively. The self-rehabilitation programme was well tolerated and safe. CONCLUSION: These results strongly suggest that a standardized self-rehabilitation programme constitutes a useful adjunct to Botulinum Toxin injections in order to improve gait-related activities.

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