Twelve chronic hemiparetic outpatients with pronounced lower limb extensor spasticity were injected with 400 units of botulinum toxin A, EMG guided into the soleus, tibialis posterior, and both heads of the gastrocnemius muscles. Botulinum toxin A caused a definite reduction of plantar flexor spasticity, in 10 patients two weeks after the injection, as assessed by the Ashworth scale. Four of the patients were able to achieve active dorsiflexion of their affected ankle. Gait analysis including the measurement of vertical ground reaction forces showed a statistically significant (p < 0.01) improvement in velocity, stride length, stance symmetry, and the length of the force point of action under the affected foot. Qualitative improvements on the force diagrams indicated a better loading, advancement of the body, and push off of the affected limb in seven patients. Eight weeks after the injection the effects waned.

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Background and Purpose Although gait training is prominent in the rehabilitation of hemiparetic stroke patients, little is known about its outcome and prognostic factors in mildly affected patients. We therefore intended to assess gait in ambulatory stroke patients before and after a 4-week inpatient rehabilitation program based on the neurodevelopmental technique.Methods We measured vertical ground reaction forces by force plates in 148 stroke patients. Variables were stance durations, peak vertical ground reaction forces at heel strike (Fzl) and toe-off (Fz2), loading and deloading rates, time to Fzl, and time to Fz2. The absolute changes for both legs and symmetry outcome were calculated. In addition, we assessed maximal walking speed, walking endurance, stair climbing ability, and the Motricity Index.Results Stance duration, weight acceptance, push-off of both legs, and the stance duration symmetry improved inde-

This 1-year follow-up study included 17 patients with spinal cord injuries who participated in a functional electrical stimulation (FES) program for restoration of the ability to stand and walk. Four tetraplegic patients reached a mean FES-assisted standing duration of 6.8 min after 6 weeks. After 1 year three patients had stopped FES-assisted standing due to orthostatic problems and only used the system for cyclic stimulation of quadriceps muscles while lying down. Ten paraplegic patients had a mean standing duration of 22.6 min. The gait velocity (gait distance) of seven patients ranged from 2.9 to 24.2 m/min (from 4 to 335 m) in seven patients. Due to flexor spasm in two and unrealistic expectations in seven cases, four patients stopped the program and five only practiced FES-assisted standing. One patient continued FES walking after 1 year. Three patients with an incomplete cervical lesion who had been able to walk a short distance before treatment achieved constant improvement their gait ability. Their gait velocity/walking distance without FES improved for a mean of +33.3%/+163.8%, after 6 weeks. Assuming that FES is used according to the level of impairment, the results favor broader application of the method in the rehabilitation of patients with spinal cord injuries.