Impact Of Physiotherapy And Botox In Improving Functional Outcomes Among Post Stroke Focal Dystonia Patients

Inclusion Criteria: * Patients having first episode of unilateral stroke * At least 6 months of post stroke duration presenting with post stroke focal dystonia of the upper limb. * No previous exposure of the affected hand of Botox. * Reduced upper limb functions * Both genders will be included equally. Exclusion Criteria: * Significant speech or cognitive impairment which impedes the ability to perform the assessment. * Other significant upper limb impairment e.g. fracture or frozen shoulder within 6 months. * Severe arthritis, amputation, evidence of fixed contracture, pregnancy or lactating womens. * Other diagnosis likely to interfere with rehabilitation or outcome assessments, e.g. blind, malignancy, * Other conditions which may contribute to upper limb spasticity, e.g. multiple sclerosis, cerebral palsy. * Use of botulinum toxin to the upper limb in the previous 4 months. * Contraindications to intramuscular injection. * Contraindications /allergy to botulinum toxin type A, which include bleeding disorders, myasthenia gravis and concurrent use of aminoglycosides.