Efficacy on gait and posture control after botulinum toxin A injection for lower-limb spasticity treatment after stroke: A randomized controlled trial

Yu, Huixian; Liu, Si-hao; Wang, Zhao-xia; Liu, Changbin; Dai, Pei; Zang, Dawei

doi:10.3389/fnins.2022.1107688

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…Therefore, we considered they compensate in two ways: increased neural synchronous and greater muscle activation. The diagnosis of pathological muscles conditions of two sides was accordance with characteristics of muscle conditions of ankle-foot motor dysfunctions in hemiplegia patients [25,28].…”

Section: Neuromuscular Tracing Based On the DCsupporting

confidence: 56%

Validation of a Newly Diagnosis Model of Dynamical Electromyography Network for Neuromuscular Tracing in Hemiplegic Ankle-Foot Motor Dysfunctions

Geng

et al. 2023

Preprint

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Background: The rating scales cannot locate and quantitatively identify muscles responsible for ankle-foot motor dysfunctions in hemiplegia patients. Object: To trace calf muscles responsible for neuromuscular dysfunction in hemiplegia patients, using a newly designed diagnosis model of dynamical surface electromyography (sEMG) network. Methods: Observe the characteristics of eight groups of muscles in bilateral calves in 14 male patients with hemiplegia and 10 age- and sex-matched healthy adults in static standing position, with two linear indices, root mean square (RMS) and median frequency (MF), and five nonlinear network indices, average interlayer mutual information (I), average edge overlap (ω), clustering coefficient (C), average shortest path length (L), and degree centrality (DC). Results: The RMS of the anterior tibialis (AT), medial gastrocnemius (MG), soleus (SOL) on the affected sides was lower than those on the other sides (P<.05). The MF of the extensor digitorum longus (EDL) on the affected sides was significantly lower than that of the unaffected sides and control groups (P<.05).I, W, and C of the unaffected side were significantly higher than those of the affected sides and the control group, whereas L was lower (P<.05). Compared to the control group, the DC of the AT and EDL on the unaffected sides were higher (P < .05), and that of the MG on the affected sides was lower (P<.05). Conclusion: In this study, the affected EDL was diagnosed as a passive eccentric muscle, and the gastrocnemius and FDL were prone to paralysis, and in which the FDL was accompanied by hyperresponsiveness. The diagnosis of pathological muscles conditions was accordance with characteristics of muscle conditions of ankle-foot motor dysfunctions in hemiplegia patients. Therefore, the newly designed diagnosis system may locate and quantitatively identify muscles responsible for hemiplegia patients, and the targeted treatments for these muscles might be carried out accurately. Clinical trial registration number: ChiCTR2100055090.

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Section: Neuromuscular Tracing Based On the DCsupporting

confidence: 56%

Validation of a Newly Diagnosis Model of Dynamical Electromyography Network for Neuromuscular Tracing in Hemiplegic Ankle-Foot Motor Dysfunctions

Geng

et al. 2023

Preprint

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Effects of Limbs’ Spasticity on Spinopelvic Alignment in Post-Stroke Patients: A Cross-Sectional Study

Bissolotti,

Brojka,

Vezzoli

et al. 2024

JCM

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Objectives: This study aimed to determine the impacts of upper and lower limb (UL and LL) spasticity and impairment on spinal alignment in chronic post-stroke patients. Methods: A total of 45 consecutive chronic post-stroke patients, 18 women and 27 men, from 18 to 70 years old who presented post-stroke hemiparesis were recruited in this cross-sectional study. The clinical assessment included the Modified Ashworth Scale (UL-MAS and LL-MAS spasticity), Upper Limb Motricity Index (UL-MI), FAST-UL, and Five Times Sit-to-Stand Test (5T-STS); the Associated Reaction Rating Scale was used to measure associated reactions in the hemiparetic UL, the plumb line distance from the spinous process of C7 on the sagittal (PL-C7s) and frontal plane (Pl-C7f), the kyphosis apex (PL-AK), and the spinous process of L3 (PL-L3). Angular measures of spinal alignment were measured by a Bunnell scoliometer™ (angle of trunk rotation—ATR) and a gravity-dependent inclinometer (inclination at C7-T1 and T12-L1). Results: In chronic post-stroke patients, there was found to be an association between the 5T-STS and PL-C7f (β = 0.41, p = 0.05) and the angle of inclination at T12-L1 (β = 0.44, p = 0.01). The FAST-UL correlated with PL-C7f (β = −0.41, p = 0.05), while the UL-MI correlated with this last parameter (β = −0.36, p = 0.04) and the ATR (β = −0.31, p = 0.05). The UL-MAS showed correlation with the ATR (β = 0.38, p = 0.01). Conclusions: The results lead to the possibility that, in chronic post-stroke patients, spinal misalignment on the frontal and sagittal plane is associated both with strength impairment and UL spasticity. The improvement or restoration of spinopelvic parameters can take advantage of therapeutic interventions targeted at motor improvement and spasticity reduction of the hemiparetic side.

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Gait Reconstruction Strategy Using Botulinum Toxin Therapy Combined with Rehabilitation

Hara,

Takekawa,

Abo

2024

Toxins

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Numerous studies have established a robust body of evidence for botulinum toxin A (BoNT-A) therapy as a treatment for upper motor neuron syndrome. These studies demonstrated improvements in spasticity, range of joint motion, and pain reduction. However, there are few studies that have focused on improvement of paralysis or functional enhancement as the primary outcome. This paper discusses the multifaceted aspects of spasticity assessment, administration, and rehabilitation with the goal of optimising the effects of BoNT-A on lower-limb spasticity and achieving functional improvement and gait reconstruction. This paper extracts studies on BoNT-A and rehabilitation for the lower limbs and provides new knowledge obtained from them. From these discussion,, key points in a walking reconstruction strategy through the combined use of BoNT-A and rehabilitation include: (1) injection techniques based on the identification of appropriate muscles through proper evaluation; (2) combined with rehabilitation; (3) effective spasticity control; (4) improvement in ankle joint range of motion; (5) promotion of a forward gait pattern; (6) adjustment of orthotics; and (7) maintenance of the effects through frequent BoNT-A administration. Based on these key points, the degree of muscle fibrosis and preintervention walking speed may serve as indicators for treatment strategies. With the accumulation of recent studies, a study focusing on walking functions is needed. As a result, it is suggested that BoNT-A treatment for lower limb spasticity should be established not just as a treatment for spasticity but also as a therapeutic strategy in the field of neurorehabilitation aimed at improving walking function.

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Efficacy on gait and posture control after botulinum toxin A injection for lower-limb spasticity treatment after stroke: A randomized controlled trial

Cited by 3 publications

References 29 publications

Validation of a Newly Diagnosis Model of Dynamical Electromyography Network for Neuromuscular Tracing in Hemiplegic Ankle-Foot Motor Dysfunctions

Validation of a Newly Diagnosis Model of Dynamical Electromyography Network for Neuromuscular Tracing in Hemiplegic Ankle-Foot Motor Dysfunctions

Effects of Limbs’ Spasticity on Spinopelvic Alignment in Post-Stroke Patients: A Cross-Sectional Study

Gait Reconstruction Strategy Using Botulinum Toxin Therapy Combined with Rehabilitation

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