Inclusion Criteria- first onset.
- at least onset before 6 months.
- elbow, wrist and fingers are above Modified Ashworth Scale(MAS) 1+.
- Mini-Mental State Exam above 24.
- can follow all of the follow up and instruction.
- patients never accept botox, phenol and alcohol injections before.
Exclusion Criteria- contracture deformity on upper extremity.
- patients had accepted botox before or had have phenol, alcohol injections and operation 6 months ago.
- allergy to botox.
- have neither infection nor skin disorder on inject site.
- now accept aminoglycoside or other medicine treatment which may affect neuromuscular transition.
- combine other systemic disease of neurological or skelectomuscular system
- cognition disorder or aphasia after stroke.