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OBJECTIVE: The aim of this study was to assess the efficacy of botulinum toxin type A injections in reducing pain, impairment, and disability in patients who have had a stroke with shoulder pain and spasticity. DESIGN: In this prospective randomized, double-blind, placebo-controlled trial, adults (n = 37) with post-stroke shoulder spasticity were screened for preinjection spasticity, rated 3 or 4 on the Modified Ashworth Scale for the shoulder adductors/internal rotators and shoulder pain. After the baseline screening, 21 subjects were randomized to receive either onabotulinumtoxinA (Botox; 140-200 units), into the pectoralis major with or without injections to the teres major, or placebo (saline) injections. Daily pain ratings using visual analog scales of best and worst pain and Disability Assessment Scale for dressing, hygiene, pain, and cosmesis; McGill Pain Questionnaire-Short Form; Fugl-Meyer Scale; upper limb range of motion; and Modified Ashworth Scale scores were assessed at baseline and 2, 4, and 12 wks after injection. Primary outcomes were assessed at week 4. RESULTS: The subject groups were well matched at baseline. Both the botulinum toxin type A and placebo groups showed decreased pain scores at 4 wks (P's < 0.05), with no significant differences between the groups found for any of the daily pain ratings (P's > 0.05). Significant improvement (P < 0.05) in change scores for hygiene on the Disability Assessment Scale was found in the botulinum toxin type A group compared with the placebo group at week 4, and there was a similar trend toward significance for improvement on the Disability Assessment Scale dressing scale (P = 0.061). CONCLUSIONS: Although botulinum toxin type A shoulder muscle injections in patients who have had a stroke with spasticity and shoulder pain resulted in improvement in selected disability measures, the observed pain reduction was not greater than that found for placebo.

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Caregivers (CGs) of stroke survivors assume their role suddenly and with little preparation. Negative emotions are common, persist over time, and are related to other negative outcomes. This pilot study, guided by a coping model, examined the efficacy and durability of a caregiver problem-solving intervention (CPSI) on CG and stroke survivor outcomes. Additional aims included assessment of feasibility issues and reliability and sensitivity of the study measures. The nonrandom sample of 15 stroke CGs was matched on depression and demographics with a comparison group. The CPSI started during acute rehabilitation and continued through 2 months after discharge. Parametric and nonparametric tests were used to assess achievement of the aims. CG depression, anxiety, preparedness, and survivor motor function improved significantly in the intervention group over time. Burden, life changes, and taking care of CG's own needs did not change significantly. CPSI group CG depression significantly improved compared with the matched group. The improvement in outcomes for the CPSI group supports further testing of the intervention with a large sample.

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PURPOSE: This is a report on a pilot study of small writing groups to assist in long-term adaptation after stroke onset. METHOD: 26 stroke survivors participated in a small group experience to write a short essay to be published about their recovery. The sample consisted of middle-aged, well-educated participants who were several years post stroke and were self-selected by interest and experience in writing. The sample was evenly divided between men and women, and minority racial groups were adequately represented. Essays were published on a website and clustered in themes about coping with recovery and personal growth/changes in self-concept. RESULTS: The group experience was well received by participants. Objective measures showed a trend toward improvement in positive identity and no significant change in depression or well-being. Significant differences found between subgroups (improved vs. declined; aphasia vs. no aphasia) are discussed. Anecdotal observations of the group process and implications for practice and further research are provided.

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The education of stroke patients and their families on prevention of recurrent stroke is a rehabilitation challenge. The principal objective of this article is to share a process for creating a stroke education program that improves patient and caregiver knowledge of secondary prevention, stroke signs and symptoms, modifiable risk factors, and maintenance of functional independence. During stroke recovery, patient education is a continuous journey. The education program needs to take into consideration the individual's readiness to learn, unique learning styles, and timing of sessions. In our educational program, Healthy Living After Stroke, we used the stroke team to develop different venues of learning.