The aim of this study is to determine whether early use of OnabotulinumtoxinA is more effective to improve functional outcomes of upper limb in patients with stroke.

Many patients surviving stroke have significant impairment of function in the affected upper limb due to the development of spasticity. Botulinum toxin type A injection is a powerful treatment option for control of spasticity. In this study, the patients will be randomly assigned into three groups: early OnabotulinumtoxinA group will receive OnabotulinumtoxinA injection when their spasticity develop, late OnabotulinumtoxinA group will have injection at 6 months after emergence of spasticity, the third group will not have OnabotulinumtoxinA intervention. The aim of this randomized controlled study is to evaluate the effects of early and late injection of botulinum toxin type A on upper limb function in patients with stroke.

Inclusion Criteria:

• stroke affecting one body side
• spasticity develops after stroke

Exclusion Criteria:

• musculoskeletal conditions that affected upper limb function prior to stroke
• concurrent use of anti-spasticity medications
• patients with neuromuscular junction or myopathic disorders such as myasthenia gravis or others
• patients with a known allergy to any onabotulinumtoxinA or to any of the excipients of onabotulinumtoxinA (such as human serum albumin)
• patients who are pregnant or may become pregnant at the time of the proposed injection