There is a myriad of literature on the benefits of reducing spasticity on rehabilitation training effects regarding AHF and AHSP in chronic stroke patients. However, thus far little evidence is available on the added-value of early spasticity reduction during rehabilitation training on the improvement of AHF and AHSP in sub-acute stroke patients. In a large study (n>300), recruited stroke patients in the sub-acute phase, but this study could not demonstrate improved active function reported small benefits as to improve passive AHF. Baker et al found modest but significant improvements on active AHF, although evidence quality was reported as being low. A number of studies explored the added value of armhand rehabilitation immediately after the injection of botulinum toxin did not find botulinum toxin plus rehabilitation to be superior to placebo plus rehabilitation with respect to AHF improvement reported improved AHF in stroke patients with a moderately to mildly impaired arm-hand who received botulinum toxin in combination with a tailored arm-hand rehabilitation program. Reducing the influence of the spastic component demands a holistic multidisciplinary approach to combine spasticity management and rehabilitation to optimize the likelihood of positive treatment effects.