Post-Stroke Recovery and the Role of Botox

When my stroke occurred, it dramatically altered my body. The right side was paralysed, while I am walking, this paralysis leaving me to navigate life with only my left hand. Pre-stroke, I was right-handed, so this change impacted my daily life and functionality, even as I made strides over a decade of recovery.

My journey involved natural progress and intensive therapy, including speech therapy, occupational therapy (OT), and physiotherapy. A pivotal part of this recovery was discovering Botox—not for its popular cosmetic uses, but for managing muscle spasticity.

Initially, I knew Botox only as a treatment for wrinkles, remembering when AFL Footy Show’s Sam Newman had it done on air. However, I learned that Botox serves a much broader medical purpose. As Professor Susan Hillier from the Stroke Foundation Clinical Council explains:

"When a stroke occurs, control signals from the brain to muscles can be damaged. As a result, the muscles may become too active, making them feel stiff and tight. This is called spasticity. Botox can help people with stroke move more easily or with less pain and discomfort."

Treating muscle spasticity often involves staying active. In severe cases, doctors may prescribe medications, with botulinum toxin A (e.g. Botox) being a common option. It’s injected into the affected muscle to enhance movement and reduce stiffness, with effects lasting up to three months. Treatment should always be paired with physiotherapy or occupational therapy, guided by a spasticity specialist.

Botox is just an adjunct to managing the challenges of stroke rehab. The medication works on specific muscles that are overworked to allow for intensive therapy to less dominant or weakest muscles to be strengthened to minimise the impact of the spastic muscle. 

The treatment is applied by initially injecting an electrode into the muscle to determine if the correct muscle will be injected with the medication. The electric pulse travels down the needle into the muscle, activating it involuntarily to confirm the correct spot. In some cases, like the ties and hands where there are multiple muscles running alongside each other this process can be really tedious, and painful! In my experience one time, it took multiple attempts over 15 minutes of probing and proving to find the precise point.

My Introduction to Botox

I first encountered Botox during my inpatient stay at Caulfield Hospital in 2014. Before my first injection, I was nervous—most people dislike needles. Yet, the hope of regaining some functionality outweighed my fear. At the time, brain fog prevented me from fully understanding the procedures, but with my supportive wife (a physiotherapist) and trusted medical team, I felt reassured.

The injections themselves were less daunting than I anticipated. My limited sensation in the affected arm meant I rarely felt pain. The initial effects were subtle, but my OT noted a small improvement. A year later, another round of Botox brought noticeable changes in sensation, which, although more painful, indicated that my arm was responding.

Over the years, I’ve had more than 20-30 Botox treatments targeting my arm, fingers, thumb, toes, calves, hamstrings, and shoulders at Caulfield Hospital and later Epworth. Most treatments yielded positive outcomes— enhanced mobility, strength, and reduced muscle tightness.

The Ups and Downs

Not every experience was perfect. About four years post-stroke, an injection in my thumb affected my ability to perform daily tasks, impacting even simple things like my handshake. Another challenging instance was when I received Botox in my toes. Post-stroke, my toes curled downward in a condition known as Claw Toe, which was particularly painful when walking barefoot. I endured the pain for a number of years and I used lots of strategies to overcome this - including toe separators and band-Aids to cover my wounds. Although Botox didn’t correct the clawing, and the needles in my toes were extremely painful, it unexpectedly numbed the pain, an outcome that, while imperfect, brought some relief. 

Moving Forward

Botox remains a vital part of my recovery plan. My Splatt surgery last year, which was aided by Botox pre- and post-operation and I’m still driven to achieve goals like running, hiking, and enhancing the functionality of my arm and shoulder (hopefully I will update about my surgery soon).

Maintaining and improving strength in affected areas is a long-term priority. For those considering Botox as part of their rehabilitation, consulting with medical professionals and setting clear recovery goals is essential. Botox may not be a complete solution, but it can be an effective tool in pursuing a better quality of life.