Participants assigned to Cohort 1 (determined by a randomization scheme) will also be scheduled for weekly therapy appointments to begin within 2 weeks of injection. An attempt will be made to have all study patients seen by the same therapists at each site and efforts will be made to standardize therapy as much as possible. The evaluating therapist who is blinded to treatment assignment will complete the Fugl-Meyer upper extremity subsection every 6 weeks and the FIM at week 1 and at the final visit. Participants will be seen every 6 weeks by the coordinator and physician for Study Visits 2, 3/3A, 4, and 5 at which time they will have the following assessments: Modified Ashworth Scale (MAS), , Patients' Disability and Carer Burden Rating Scale, Visual Analog Scale and the Disability Assessment Scale. The participants in Cohort 2 will follow the same injection and assessment schedule (including Fugl-Meyer upper extremity subsection every 6 weeks and FIM at week 1 and at the final visit), but will not participate in therapy. If, by visit 3, the participants' upper limb spasticity has reached a MAS score of 2 or greater in the wrist and/or fingers, they will be eligible for a second injection of BoNT-A. Any subjects who do not meet re-injection criteria by Visit 3 (week 12) will be re-evaluated in another 3 weeks, Visit 3A. If participants do not meet re-injection criteria by Study Visit 3A (week 15) they will not receive another injection, but will be followed until Visit 5 (final visit). If subjects are injected at visit 3A, visit 4 will occur at 21 weeks (6 weeks after 2nd injection). Visit 5 will occur at week 27 (12 weeks after 2nd injection). Participants receiving both injections will complete the study no sooner than Study Visit 5. The expected time to recruit patients and complete the study is 18 months.