Contralateral seventh cervical nerve transfer can affect the pennation angle of the lower limb in spastic hemiplegia patients: An observational case series study

Abstract

IntroductionWe previously reported transferring seventh cervical (C7) nerve from unaffected side to affected side in patients with spastic hemiplegia due to chronic cerebral injury, to improve function and reduce spasticity of paralyzed upper limb. In the clinics, some patients also reported changes of spasticity in their lower limb, which could not be detected by routine physical examinations. Pennation angle of muscle can indirectly reflect the condition of spasticity. The purpose of this study was to evaluate whether this upper limb procedure may affect spasticity of lower limb, using ultrasonography to detect changes of muscle pennation angle (PA).MethodsTwelve spastic hemiplegia patients due to cerebral injury including stroke, cerebral palsy, and traumatic brain injury, who underwent C7 nerve transfer procedure, participated in this study. B‐mode ultrasonography was used to measure PA of the gastrocnemius medialis (GM) muscle at rest preoperatively and postoperatively. The plantar load distribution of the lower limbs was evaluated using a Zebris FDM platform preoperatively and postoperatively.ResultsThe PA of the GM was significantly smaller on the affected side than that of unaffected side before surgery. On the affected side, the postoperative PA was significantly larger than preoperative PA. On the unaffected side, the postoperative PA was not significantly different compared to preoperative PA. The postoperative plantar load distribution of the affected forefoot was significantly smaller than preoperative load distribution, which was consistent with ultrasonography results.ConclusionsThis study indicates that C7 nerve transfer surgery for improving upper limb function can also affect muscle properties of lower limb in spastic hemiplegia patients, which reveals a link between the upper and lower limbs. The interlimb interactions should be considered in rehabilitation physiotherapy, and the regular pattern and mechanism need to be further studied.

Impairment characteristics of static balance and plantar load distribution of patients undergoing tibial cortex transverse distraction for diabetic foot ulcers

“…The condition is complex and the treatment methods used are diverse, and often not particularly effective. The TCTD procedure can stimulate the regeneration of peripheral tissue by applying transverse, slow and continuous traction to the bone window of the tibial cadre [ 11 , 15 ]. This promotes the regeneration of the bone window and the distal microvascular network, ameliorating the ischemia and hypoxia of distal tissue, thereby reducing the ischemic necrosis and neuropathy associated with diabetic foot and permitting healing.…”

“…This promotes the regeneration of the bone window and the distal microvascular network, ameliorating the ischemia and hypoxia of distal tissue, thereby reducing the ischemic necrosis and neuropathy associated with diabetic foot and permitting healing. [ 11 , 15 ]…”

“…1 ). [ 15 , 16 ] The larger value of COP ellipse sway area and COP path length were, the worse was the participant’s static balance. Large θ angles indicated that the instability was principally lateral, whereas small θ angles indicated that the instability was principally anterior–posterior.…”

Customized Neurotization for Hindlimb Hemiplegia After a Hemorrhagic Stroke

“…Given currently dissatis ed outcomes and large HICH populations, we need additional intervention to limb hemiplegia [32][33][34][35].Rationales behind the previous C7-to-C7 transfer for the paretic upper limb are beginning to be accepted and understood as scalability [36][37][38][39][40].Reinnervation of the denervated muscles,γ-circuit interruption,and establishing a new pathway remarkably contributed to a motor recovery post-transfer [41,42]. Contralateral lumbar neurotization engaging the similar mechanisms was considered available for a lower limb paresis after central neurological injury.Thus,in this project,we would rather extend the L4-to-L4 transfer to hindlimb hemiplegia than other transfer modalities in rats.…”

Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery

“…However, the outcome was limited to the penetration angle of the gastrocnemius muscle and the plantar load, two indirect measures of subtle changes in lower extremity spasticity in the absence of clinical improvement. Although significant from a statistical standpoint, the effect on lower extremity function remains of indeterminate clinical significance [ 24 ]. Additionally, the underlying pathophysiological mechanism of this effect remains unclear, but the authors propose that proprioceptive signaling via a previously described cervicolumbar reflex could be implicated in this process as described by Delwaide et al [ 25 ].…”