Comprehensive evaluation of gait, spasticity, and muscle morphology: A case report of a child with spastic paresis treated with Botulinum NeuroToxin‐A, serial casting, and physiotherapy

Weide, Guido; Sloot, Lizeth H.; Oudenhoven, Laura M.; Jaspers, Richard T.; Harlaar, Jaap; Buizer, Annemieke I.; Bar‐On, Lynn

doi:10.1002/ccr3.2227

Cited by 3 publications

(2 citation statements)

References 47 publications

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“…This effect disappears soon as the tension is removed [37]. This result is compatible with the result of [38] who found that stretching exercises for wrist flexors is not significant to reduce spasticity and [39] claimed that stretching the ankle plantar flexors for 30 minutes improved ankle joint stiffness but had no impact on gait. Also, stretching exercises do not result in the plastic changes in the central nervous system needed to permit adaptation to the demands of any motor activity after repeated training, it makes sense that a few muscle stretching sessions have little to no impact on the functional plasticity of the neuronal circuits in the spinal cord [40].…”

Section: Discussionsupporting

confidence: 77%

“…Also, stretching exercises do not result in the plastic changes in the central nervous system needed to permit adaptation to the demands of any motor activity after repeated training, it makes sense that a few muscle stretching sessions have little to no impact on the functional plasticity of the neuronal circuits in the spinal cord [40]. had no effect on the gait [39].…”

Section: Discussionmentioning

confidence: 99%

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Electromotive Drug Administration of Magnesium Sulphate on Spastic Gastrocnemius Muscle of Stroke Patients

Hassan¹,

Elkebalawy²,

Elerian³

et al. 2022

Journal of Pharmaceutical Negative Results

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Objective: This study aimed to investigate the effects of Magnesium sulfate (MgSO4) iontophoresis on electrical activity and functional ability (step length of the affected side) of the gastrocnemius muscle Methods: A total of 50 patients aged 45_65 years of both genders who were diagnosed with chronic cerebrovascular accident (29 females and 21 males) were recruited in this study and randomly assigned into 2 equal groups. Subjects in Group A received MgSO4 iontophoresis in addition to passive stretching of the gastrocnemius for two session per week for 4 weeks, whereas group B underwent calf, quadriceps and hamstring muscle stretching for two sessions per week for 4 weeks. Electromyography was used to measure the electrical activity of the gastrocnemius muscle during rest and activity times (active plantar flexion) whereas the Biodex Gait Trainer 2 was used to measure the step length of the affected side; thus, patients were evaluated twice before and after allocation to each group. Results: Statistical analysis showed a significant change within all study variables when comparing pretreatment with posttreatment values in group A (p < 0.05) but not in group B (p > 0.05). Between-group analysis showed no significant changes in pretreatment values of all variables as (p > 0.05), whereas a significant change in all variables was observed in posttreatment values (p < 0.05). Conclusion: MgSO4 iontophoresis is more effective than traditional therapy (stretching) in managing the spasticity of poststroke patients.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Electromotive Drug Administration of Magnesium Sulphate on Spastic Gastrocnemius Muscle of Stroke Patients

Hassan¹,

Elkebalawy²,

Elerian³

et al. 2022

Journal of Pharmaceutical Negative Results

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Comparative analysis of the effect trunk-hip-knee-ankle foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy (case report)

Koltsov

Aksenov²,

Dzhomardly

2021

Medical and Social Expert Evaluation and Rehabilitation

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BACKGROUND: In children with spastic forms of cerebral palsy often prescribed difference type of trunk-hip-knee-ankle foot orthosis (THKAFO). At the same time, we have not found any significant reports in the world literature dedicated to the study of the influence of these orthosis on the gait biomechanical parameters. AIM: To demonstrate the results of a comparative analysis of the effect of trunk-hip-knee-ankle-foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy. MATERIALS AND METHODS: The study involved two 13-and 15-year-old children with a diagnosis of cerebral palsy, spastic diplegia, GMFCS 3, MACS 23, Ashworth Scale 23. Six studies were conducted ― three tests for each child (barefoot, in AFO and THKAFO) using the 3D video analysis system Qualisys (Sweden). The spatio-temporal and kinematic indicators of gait, as well as the gait index, were evaluated. RESULTS: Analysis of the results in patient D. demonstrated that using the THKAFO in comparison with AFO led to a slight improvement in spatio-temporal gait indicators (from 4.012.5%), but to a deterioration in hip kinematics and a deterioration in the gait index (2.528.1%). Whereas in patient A., it was noted that the use of the THKAFO in comparison with AFO had a negative effect on the spatio-temporal parameters of gait (4.097.6%), on the kinematics of the knee and ankle joints, and on the improvement of the hip kinematics in the sagittal plane, but the effect on the gait index was not unambiguous. According to the totality of the analyzed data, patient D. was recommended to wear AFO instead of the THKAFO. Patient A. was also recommended to wear an AFO instead of a THKAFO, even despite the ambiguous results of the biomechanical research, since the final decision on the choice of the orthosis design took into account not only accurate changes in biomechanical parameters, but also a number of other factors, in particular social and household ones. CONCLUSION: In patients with level GMFCS 3, for improve the biomechanical parameters of gait, it is advisable to give preference to shorter and functional orthoses before prescribing orthoses that capture two or more body segments.

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Noninvasive analysis of overactive muscle structure and elasticity after botulinum toxin type A injection: a systematic review and meta-analysis

DEVIS,

LECOUVET,

LEJEUNE

et al. 2024

Eur J Phys Rehabil Med

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INTRODUCTION Injections of botulinum toxin type A (BoNT-A) are the first-line treatment for spastic muscle overactivity (MO). Some authors observed that BoNT-A injections lead to changes in muscle structure and muscle elasticity that are probably not completely reversible. This possible effect is critical, as it could lead to negative impacts on the effectiveness of BoNT-A interventions. Our study aimed to evaluate the current literature regarding changes in muscle elasticity and structure after BoNT-A injection, by diagnostic imaging, in neurological populations with MO. Our second objective was to pool all articles published on this topic in order to provide a quantitative synthesis of the data. EVIDENCE ACQUISITION A systematic search was conducted between October 2021 and April 2023 using different databases in accordance with PRISMA guidelines. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the studies. A meta-analysis was performed to compare muscle elasticity and structure before and after BoNT-A injections. EVIDENCE SYNTHESIS A sample of 34 studies was selected for qualitative review and 19 studies for quantitative review. Meta-analysis of pre-post studies demonstrated significant improvement with a medium effect size (standardized mean difference=0.74; 95% CI 0.46-1.02; P<0.001) of muscle elasticity assessed by ultrasound elastography (USE) 4 weeks after BoNT-A injection. No statistically significant difference was found for muscle thickness, pennation angle, and muscle echo-intensity assessed by magnetic resonance imaging and/or ultrasonography at short-term. On the other hand, normalized muscle volume decreased with a small effect size (standardized mean difference = -0.17; 95% CI -0.25 - -0.09; P<0.001) 6 months after BoNT-A injection. CONCLUSIONS Muscle elasticity measured by USE improves with a temporary effect at short-term following BoNT-A injections. Synthesis of studies that assesses muscle structure is hindered by methodological differences between studies. However, based on a small amount of data, normalized muscle volume seems to decrease at long-term after BoNT-A injections in children with CP suggesting that the timing of re-injection should be considered with caution in this population. Further work should focus on the long-term effect of repeated injections on muscle structure and elasticity in neurological populations.

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Comprehensive evaluation of gait, spasticity, and muscle morphology: A case report of a child with spastic paresis treated with Botulinum NeuroToxin‐A, serial casting, and physiotherapy

Cited by 3 publications

References 47 publications

Electromotive Drug Administration of Magnesium Sulphate on Spastic Gastrocnemius Muscle of Stroke Patients

Electromotive Drug Administration of Magnesium Sulphate on Spastic Gastrocnemius Muscle of Stroke Patients

Comparative analysis of the effect trunk-hip-knee-ankle foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy (case report)

Noninvasive analysis of overactive muscle structure and elasticity after botulinum toxin type A injection: a systematic review and meta-analysis

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