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Figure 2: (A) Botulinum A toxin injection targeting the intrinsic muscles of the hand. (a) Before injection: It is difficult to extend the fingers passively in the patients with spastic flexed fingers due to the rigidity of fingers (Modified Modified Ashworth Scale Grade 4), and for injection, each finger should be forcedly extended. (b) One month after injection: Although there is mild contracture in proximal and distal interphalangeal joints, all fingers are easily extended passively with minimal resistance (Modified Modified Ashworth Scale Grade 1) and the photo shows that the patient is easily extending his thumb with unaffected hand. (B) Botulinum A toxin injection into the intrinsic muscles of the hand. (a) Before injection: The wrist and fingers of the patient were flexed, and it was difficult for her to extend wrist and fingers by herself because of strong rigidity (Modified Modified Ashworth Scale Grade 4). (b) One month after injection: There is no increase in muscle tone in wrist and fingers after the treatment (Modified Modified Ashworth Scale Grade 0). The patient can move her wrist naturally and extend her affected fingers by putting her unaffected hand gently on the affected fingers

Figure 2: (A) Botulinum A toxin injection targeting the intrinsic muscles of the hand. (a) Before injection: It is difficult to extend the fingers passively in the patients with spastic flexed fingers due to the rigidity of fingers (Modified Modified Ashworth Scale Grade 4), and for injection, each finger should be forcedly extended. (b) One month after injection: Although there is mild contracture in proximal and distal interphalangeal joints, all fingers are easily extended passively with minimal resistance (Modified Modified Ashworth Scale Grade 1) and the photo shows that the patient is easily extending his thumb with unaffected hand. (B) Botulinum A toxin injection into the intrinsic muscles of the hand. (a) Before injection: The wrist and fingers of the patient were flexed, and it was difficult for her to extend wrist and fingers by herself because of strong rigidity (Modified Modified Ashworth Scale Grade 4). (b) One month after injection: There is no increase in muscle tone in wrist and fingers after the treatment (Modified Modified Ashworth Scale Grade 0). The patient can move her wrist naturally and extend her affected fingers by putting her unaffected hand gently on the affected fingers