Managing spastic foot drop after stroke

Ward, Anthony B.

doi:10.1111/ene.12404

Cited by 12 publications

(5 citation statements)

References 9 publications

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“…BoNT-A injection into plantar flexor muscles reduces muscle tone and improves ankle range of motion. Many muscles are responsible for equinus foot deformity (e.g., medial and lateral gastrocnemius, soleus, tibialis posterior, flexor hallucis longus and brevis, flexor digitorum longus and brevis, and extensor hallucis brevis), but since the gastrocnemius and the soleus are mainly involved in this posture, BoNT-A treatment targets these muscles to reduce the drive to plantarflexion [15,16]. However, it is still unclear whether BoNT-A can improve voluntary control of residual strength or gait ability in chronic stroke patients [17,18,19].…”

Section: Introductionmentioning

confidence: 99%

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Cinone

Letizia

Santoro

et al. 2019

Toxins

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Botulinum toxin A (BoNT-A) has been shown effective for poststroke lower limb spasticity. Following injections, a wide range of multidisciplinary approach has been previously provided. The purpose of this pilot, single-blind, randomized controlled trial was to determine whether BoNT-A combined with a regime of a four-week ankle isokinetic treatment has a positive effect on function and spasticity, compared with BoNT-A alone. Secondly, the validity of the use of an isokinetic dynamometer to measure the stretch reflex at the ankle joint and residual strength has been investigated. Twenty-five chronic stroke patients were randomized to receive combined treatment (n = 12; experimental group) or BoNT-A alone (n = 13; control group). Outcome measures were based on the International Classification of Functioning, Disability and Health. An isokinetic dynamometer was also used for stretch reflex and strength assessment. Patients were evaluated at baseline (t0), after five (t1) and eight weeks after the injection (t2). The experimental group reported significantly greater improvements on lower limb spasticity, especially after eight weeks from baseline. Gait speed (10-m walk test) and walking capacity (6-min walking test) revealed statistically significantly better improvement in the experimental than in control group. Peak resistive ankle torque during growing angular velocities showed a significant reduction at the higher velocities after BoNT-A injections in the experimental group. Peak dorsiflexor torque was significantly increased in the experimental group and peak plantarflexor torque was significantly decreased in control group. Alternative rehabilitation strategies that combine BoNT-A and an intense ankle isokinetic treatment are effective in reducing tone and improving residual strength and motor function in patients with chronic hemiparesis.

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Section: Introductionmentioning

confidence: 99%

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Cinone

Letizia

Santoro

et al. 2019

Toxins

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“…Pes equinovarus is mainly caused by spasticity, contracture, weakness of the ankle dorsiflexors, and instability of the tibial and peroneal muscles [20,21].…”

Section: Discussionmentioning

confidence: 99%

Effect of two doses of botulinum toxin type A on maximum plantar contact area in hemiplegic stroke patients with pes equinovarus

Wada

Otsuka

Kawate

et al. 2020

Jpn J Compr Rehabil Sci

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Inoue Y. Effect of two doses of botulinum toxin type A on maximum plantar contact area in hemiplegic stroke patients with pes equinovarus. Jpn J Compr Rehabil Sci 2020; 11: 85-90. Objectives: To quantitatively demonstrate the therapeutic effects of two doses of botulinum toxin type A (BoNT-A) on pes equinovarus in hemiplegic stroke patients. Methods: The subjects of this study included eight chronic stroke patients who received two BoNT-A doses (mean dose interval: 136.0 (10.5) days) from April 2011 to March 2013 and underwent a sheet-type weight-bearing lower limb test. The maximum plantar contact area on the paralyzed side, ratio of maximum plantar contact areas on the paralyzed and nonparalyzed sides, and Modified Ashworth Scale (MAS) were measured before BoNT-A administration and 4 weeks after both the first and second doses. Results: A significant increase in the maximum plantar contact area was observed after administration of the second dose compared to that of the first dose on the paralyzed side. Additionally, a significant increase was observed in the ratio of paralyzed/non-paralyzed maximum plantar contact areas after the administration of both the first and second doses compared to that before BoNT-A administration. MAS was observed to decline significantly after the administration of both the first and second doses compared to that prior to BoNT-A administration. Conclusions: We suggest that comparison of the plantar contact area is useful for assessing the therapeutic effects of BoNT-A doses on pes equinovarus in hemiplegic stroke patients.

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“…In addition to the grave concern of mortality, survivors of stroke frequently grapple with substantial morbidity, most notably neurological impairments that substantially hamper their quality of life. Among these impairments, a prevalent issue is equinovarus foot, a symptom characterized by the foot being plantarflexed (downward) and inverted (turned inward), often resulting from muscle imbalances or neurological impairments [ 2 , 3 ]…”

Section: Introductionmentioning

confidence: 99%

Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial

Silva,

Morouço,

Lains

et al. 2024

JMIR Res Protoc

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Background Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process. Objective This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction. Methods A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system’s implications. Results Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates. Conclusions Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes. International Registered Report Identifier (IRRID) PRR1-10.2196/52365

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Managing spastic foot drop after stroke

Abstract: Click http://onlinelibrary.wiley.com/doi/10.1111/ene.12381/abstract to view the accompanying paper in this issue.

Cited by 12 publications

References 9 publications

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Effect of two doses of botulinum toxin type A on maximum plantar contact area in hemiplegic stroke patients with pes equinovarus

Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial

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